SIU Lead: Fraud & Data Analytics Analyst II

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a Fraud, Waste, and Abuse (FWA) Analyst II to identify potential healthcare fraud leads through data mining and claims analysis. You will contribute to SIU lead development by evaluating provider, member, pharmacy, and ancillary billing patterns for signs of fraud and abuse.

You will analyze medical and pharmacy claims, examine coding usage, and develop comprehensive lead summaries.

Qualifications

• 3+ years in healthcare data analysis, SIU, claims analysis, auditing, or fraud.
• Strong analytical and critical-thinking skills to spot trends.
• Experience interpreting large healthcare datasets and translating findings.
• Understanding of healthcare claims processing and coding methodologies.
• Willingness to travel up to 10%.

Responsibilities

• Develop proactive and reactive fraud, waste, and abuse leads from data.
• Mine claims databases, reporting tools, and investigative systems.
• Analyze CPT/HCPCS/ICD and reimbursement trends for indicators.
• Prepare lead summaries with evidence and risk indicators.
• Collaborate with investigators and business partners on findings.

Skills

Healthcare data analysis

SIU experience

Claims analysis

Analytical thinking

Data interpretation

Travel availability

Education

Bachelor's degree

Tools

SQL

Tableau

Power BI

JIRA

SAS

Job description

CVS Health Corporation is seeking a Fraud, Waste, and Abuse (FWA) Analyst II to identify potential healthcare fraud leads through data mining and claims analysis. You will contribute to SIU lead development by evaluating provider, member, pharmacy, and ancillary billing patterns for signs of fraud and abuse.

You will analyze medical and pharmacy claims, examine coding usage, and develop comprehensive lead summaries.