Senior Medicaid Fraud Investigator

CVS Health; Florida; Sur place; USD 47 000 - 102 000; Plein temps

Résumé du poste

CVS Health seeks a Senior Investigator to lead investigations of healthcare fraud and abuse, including complex cases and those involving multiple perpetrators. You will protect resources by preventing fraudulent Medicaid payments and presenting findings for legal review.

You will document activity, train junior investigators, and collaborate with providers and law enforcement. 3+ years in health care fraud is required.

Qualifications

• 3+ years of working health care fraud investigations.
• Knowledge of CPT, HCPCS, ICD-10 coding.
• Advanced Excel skills including pivot tables.
• Ability to travel up to 10% (approx. 2-3x per year).

Responsabilités

• Conduct high-level investigations of healthcare fraud and abuse.
• Handle sensitive/high-profile cases and complex fraud schemes.
• Investigate to prevent payment of fraudulent Medicaid claims.
• Document activity in case tracking system and prepare findings for review.
• Provide testimony in civil and criminal proceedings as needed.
• Cooperate with federal, state, and local law enforcement as required.

Connaissances

Healthcare fraud investigations

Analytical thinking

Strong communication skills

Formation

Bachelor's degree or equivalent experience

Outils

Excel

Pivot tables

Description du poste

CVS Health seeks a Senior Investigator to lead investigations of healthcare fraud and abuse, including complex cases and those involving multiple perpetrators. You will protect resources by preventing fraudulent Medicaid payments and presenting findings for legal review.

You will document activity, train junior investigators, and collaborate with providers and law enforcement. 3+ years in health care fraud is required.