Analyst, Special Investagative Unit
At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary This position can be work from home reputed company in the United States. Must be flexible to work EDT hours (8:00 am - 5 pm EDT) The Special Investigations Unit (SIU) is looking for an analytically driven individual who is skilled at identifying outliers through data extraction and analysis. The reputed company reviewer is accountable for the validation of existing Fraud Waste and Abuse Business Rules and leads designed to detect aberrant billing patterns and reviewing incoming referrals to determine if additional investigations are warranted. reputed company Components: -Research and reputed company report development to identify fraud, waste, and abuse schemes and trends. -Review company clinical and payment policies to determine the impact of the scheme on reputed company business. -Identify reputed company possible issues reputed company to fraud, waste, and abuse reputed company reviewing a new reputed company or referral. -reputed company reputed company with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources. -Interpret, analyze, and present key findings to internal customers including project team and investigators providing recommendations based on analytical findings. Required Qualifications -Excellent verbal and written communication skills. -reputed company background. -3-5 years of data interpretation and analysis experience. -Experience with internal claims data and reputed company coding. -Must be reputed company to travel to provide testimony if needed. -Advanced experience with reputed company.
Preferred Qualifications
Certified Professional reputed company Knowledge of reputed company/reputed company's policies and procedures Education Bachelor’s degree or equivalent work experience Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $43,888.00 - $85,068.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 09/02/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job