SIU Senior Investigator (Must reside in Florida) - Military Veterans
at CVS Health
CVS Health
To apply for this position please CLICK HERE
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
This is a work from home position but must be located in Florida. Must be flexible to work ET hours (8:00 am - 5 pm ET)
Conducts high level, complex analysis of claims and correspondence to effectively pursue the prevention, investigation and prosecution of health care fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans.
Fundamental Components:
- Conducts high level, complex investigations of known or suspected acts of healthcare fraud and abuse.
- Routinely handles cases that are sensitive or high profile, those that are national in scope, complex cases involving multi-disciplinary provider groups, or cases involving multiple perpetrators or intricate healthcare fraud schemes.
- Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, members, etc.
- Researches and prepares cases for clinical and legal review.
- Documents all appropriate case activity in case tracking system.
- Makes referrals, both internal and external, in the required timeframe.
- Facilitates the recovery of company and customer money lost as a result of fraud matters.
- Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators.
- Assists Investigators in identifying resources and best course of action on investigations.
- Serves as back up to the Team Leader as necessary.
- Communicates and cooperates with federal, state, and local law enforcement agencies to assist in the investigation and prosecution of healthcare fraud and abuse matters.
- Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings.
- Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud.
- Provides input regarding controls for monitoring fraud related issues within the business units.
- Maintains open communication with constituents within and external to the company.
- May include travel to testify in court proceedings or training if necessary.
Required Qualifications
- Must reside in Florida
- 3-5 years Investigative experience in the area of healthcare fraud, waste and abuse.
- Bilingual in English/Spanish
- Experience with the Florida Health Exchange or Individual Family Plans.
- Strong knowledge of medical terminology/CPT/HCPCS coding.
- Advanced skills with Microsoft Excel.
- Experience in healthcare/medical insurance claims investigation or professional/clinical experience.
- Background with law enforcement agencies involving economic or insurance related matters; or professional investigation experience involving economic or insurance related matters; or an authorized medical professional to evaluate medical related claims .
- Strong analytical and research skills.
- Proficient in researching information and identifying information resources.
- Proficiency in Word, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information.
- Strong verbal and written communication skills.
- Strong customer service skills.
- Ability to interact with different groups of people at different levels and provide assistance on a timely basis.
- Ability to utilize company systems to obtain relevant electronic documentation.
- Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.
Preferred Qualifications
- AHFI, CFE, Certified Professional Coder
- Knowledge of CVS/Aetna's policies and procedures
Education
- Bachelor's Degree or equivalent experience
Pay Range
The typical pay range for this role is:
$43,700.00 - $90,000.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ('PTO') or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
Tallahassee, FL
At CVS Health we are transforming health care with a shared purpose: Bringing our heart to every moment of your health™
With 300,000 dedicated colleagues including veterans, service members, Guard and Reserve, and military spouses, we are improving the health of communities across America.
We recognize the value of military service and know that the skills and experience our nation's veterans and military spouses possess are unparalleled. As a CVS Health colleague, you’ll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone’s life, including your own.
As an enduring partner with Military Spouse Employment Partnership for 20 years, we’re committed to providing long-term career potential, opportunity, and support for military spouses.
Corporate Fellowship Programs
Transitioning Service Members - For transitioning service members and Coast Guardsmen within 180 days of separation from service interested in SkillBridge programs, please reach out to YourNextMission@CVSHealth.com to learn about the career tracks that we host participants in.
Accommodation Statement
We provide reasonable accommodations to individuals with disabilities as needed. To request an accommodation – including a qualified interpreter, written information in other formats, translation or other services – please email AdviceandCounsel@cvshealth.com or call 877-805-9511. If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
EEO Statement
CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT.
Military Spouses - We offer programs throughout the year and have partnered with Hiring Our Heroes to offer a 12-week paid fellowship for military spouses. During this time, you will receive professional training and hands-on experiences across CVS Health enterprise to quickly build your network and showcase your skillset. If you are interested in Military Spouse Fellowship programs, please reach out to our partners at Hiring Our Heroes.