Senior SIU Lead: Health Fraud & Data Analytics

CVS Health Corporation; Salt Lake City (UT); On-site; USD 44,000 - 94,000; Full time

Job summary

CVS Health Corporation is seeking a Fraud, Waste, and Abuse (FWA) Analyst II to identify and develop healthcare fraud leads through data mining, claims analysis, and investigative research within our SIU team.

You will evaluate provider, member, pharmacy, and ancillary billing for signs of fraud, waste, and abuse, analyze CPT/HCPCS/ICD/DRG/NDC coding and reimbursement trends, and prepare lead summaries with evidence to support investigations.

Qualifications

• Bachelor's degree or equivalent in education and experience.
• 3+ years in healthcare data analysis or fraud-related roles.
• Experience interpreting large datasets and identifying trends.
• Knowledge of healthcare claims processing and coding.

Responsibilities

• Identify and develop potential healthcare fraud leads.
• Analyze CPT, HCPCS, ICD, DRG, NDC coding and trends.
• Prepare lead summaries with evidence and risk indicators.
• Collaborate with investigators and compliance teams.
• Ensure compliance with CMS and regulatory requirements.

Skills

Healthcare data analysis

SIU experience

Claims analysis

Analytical thinking

Education

Bachelor's degree

Tools

Tableau

SQL

JIRA

Power BI

SAS

Job description

CVS Health Corporation is seeking a Fraud, Waste, and Abuse (FWA) Analyst II to identify and develop healthcare fraud leads through data mining, claims analysis, and investigative research within our SIU team.

You will evaluate provider, member, pharmacy, and ancillary billing for signs of fraud, waste, and abuse, analyze CPT/HCPCS/ICD/DRG/NDC coding and reimbursement trends, and prepare lead summaries with evidence to support investigations.