SIU Lead - Review & Data Analytics Analyst II

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

Job summary

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

You will evaluate billing patterns across providers, members, pharmacies, and facilities, and present findings to SIU leadership. The role requires 3+ years in healthcare data analysis and strong analytical skills, with up to 10% travel.

Qualifications

• 3+ years of healthcare data analysis, SIU, claims analysis, auditing, payment integrity, or healthcare fraud experience.
• Strong analytical and critical-thinking skills.
• 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 and reactive leads to identify potential fraud, waste, and abuse.
• Analyze CPT, HCPCS, ICD, DRG, NDC, and modifier usage and reimbursement trends.
• Present analytical findings and recommendations to SIU leadership.
• Collaborate with investigators, clinicians, legal, compliance, and business partners.

Skills

Healthcare data analysis

Fraud investigation

Claims analysis

Analytical thinking

Critical thinking

Travel readiness

Education

Bachelor's degree or equivalent

Tools

Tableau

SQL

JIRA

Power BI

SAS

Job description

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

You will evaluate billing patterns across providers, members, pharmacies, and facilities, and present findings to SIU leadership. The role requires 3+ years in healthcare data analysis and strong analytical skills, with up to 10% travel.