SIU Lead Review & Fraud Analytics Analyst II

CVS Health Corporation; Saint Paul (MN); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health Corporation is seeking a Fraud, Waste, and Abuse (FWA) Analyst II to identify potential healthcare fraud leads through data mining, claims analysis, and investigative research within the SIU lead development process.

You will evaluate provider, member, pharmacy, DME, and ancillary billing patterns for indicators of fraud or abuse and translate findings into actionable leads. This role requires strong analytical skills and the ability to communicate findings to leadership.

Qualifications

• 3+ years of healthcare data analysis, SIU, or healthcare fraud experience.
• Strong analytical and critical-thinking skills.
• Experience interpreting large healthcare datasets into insights.
• Working knowledge of healthcare claims processing and coding methodologies.
• Ability to travel up to 10%.

Responsibilities

• Develop proactive and reactive leads from claims data and systems.
• Analyze CPT, HCPCS, ICD, DRG, NDC, and modifiers usage and trends.
• Present findings and recommendations to SIU leadership.
• Document investigative rationale per regulatory requirements.
• Collaborate with investigators, clinicians, legal, and business partners.

Skills

Healthcare data analysis

SIU experience

Claims analysis

Data mining

Analytical thinking

Travel up to 10%

Education

Bachelor's degree or equivalent

Tools

Tableau

SQL

JIRA

Power BI

SAS

Case management systems

Job description

CVS Health Corporation is seeking a Fraud, Waste, and Abuse (FWA) Analyst II to identify potential healthcare fraud leads through data mining, claims analysis, and investigative research within the SIU lead development process.

You will evaluate provider, member, pharmacy, DME, and ancillary billing patterns for indicators of fraud or abuse and translate findings into actionable leads. This role requires strong analytical skills and the ability to communicate findings to leadership.