Senior SIU Lead – Fraud & Data Analytics

CVS Health Corporation; Bismarck (ND); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health Corporation is seeking an Analyst II for the Fraud, Waste, and Abuse program. You will identify and develop potential healthcare fraud leads through data mining, claims analysis, and investigative research.

This full-time role collaborates with SIU investigators, clinicians, and compliance partners to evaluate billing patterns, document findings, and make actionable recommendations. Travel up to 10% is required, and a Bachelor's degree is expected.

Qualifications

• 3+ years of healthcare data analysis, SIU, claims analysis, auditing, payment integrity, or healthcare fraud experience.
• Strong analytical and critical-thinking skills with the ability to identify trends and anomalies.
• Experience interpreting large healthcare datasets and transforming findings into actionable insights.
• Working knowledge of healthcare claims processing and coding methodologies.
• Ability to travel up to 10%.

Responsibilities

• Develop proactive leads to identify potential fraud, waste, and abuse.
• Generate FWA leads by mining claims databases, reporting tools, and investigative systems.
• Validate and refine leads to assess credibility and value for investigations.
• Examine spike analyses, utilization trends, payment anomalies, and outlier reports.
• Collaborate with investigators and compliance partners to refine leads and findings.
• Present analytical findings to SIU leadership and decide on escalation or closure.

Skills

Healthcare data analysis

SIU / fraud analysis

Claims analysis

Data mining

Analytical thinking

Travel up to 10%

Large dataset interpretation

Education

Bachelor's degree

Tools

Tableau

SQL

Power BI

JIRA

SAS

Job description

CVS Health Corporation is seeking an Analyst II for the Fraud, Waste, and Abuse program. You will identify and develop potential healthcare fraud leads through data mining, claims analysis, and investigative research.

This full-time role collaborates with SIU investigators, clinicians, and compliance partners to evaluate billing patterns, document findings, and make actionable recommendations. Travel up to 10% is required, and a Bachelor's degree is expected.