The Special Investigations Unit (SIU) Investigator conducts investigations to prevent, investigate, and prosecute healthcare fraud and abuse, recover lost funds, and ensure compliance with federal and state fraud regulations.
This role supports Aetna/CVS Health’s efforts to maintain integrity in healthcare operations and protect members, patients, and financial resources.
Requirements & Qualifications
Required Qualifications
- 1-3 years of investigative experience in healthcare fraud, waste, and abuse.
- Experience with Microsoft Word, Excel, and Outlook.
- Experience using open-source database search tools, social media, and internet research.
- Ability to travel for business purposes and legal proceedings.
Preferred Qualifications
- Certified Professional Coder (CPC), AHFI, or CFE.
- Bilingual English/Spanish.
- Dental investigative experience.
- Dental clinical experience.
- Knowledge of CDT and ADA.
- Commercial/Medicare experience.
- Strong communication and customer service skills.
- Ability to exercise independent judgment and use available resources and technology to develop evidence for case investigations.
Education
- Bachelor’s degree in Criminal Justice, Healthcare Management, Public Health, Biological Sciences, Data Analytics, or a related field preferred, or equivalent experience.
Benefits & Perks
Full-time position with a comprehensive benefits package that may include:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Bonus, commission, or short-term incentive eligibility
Location
Connecticut, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$43,888 - $93,574
Remote work allowed
No
Posted
1 month ago
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