Manager, Special Investigations Unit

CVS Health

. Lead investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and compliance concerns .

Posted 11/12/2026full-timeIllinois • United StatesMid-LevelSenior💰 $54,300 - $145,860 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in health care fraud, waste, and abuse investigations, with a strong focus on compliance and risk management. Proven leadership in managing investigative teams and workflows while ensuring adherence to regulatory standards.

Highest-signal resume keywords

Health Care Fraud InvestigationsLeadership ExperienceAnalytical SkillsRegulatory ComplianceInvestigative Practices

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative WorkRisk-Based Decision-MakingDocumentation StandardsCase ManagementData Analysis

Soft Skills

Problem-SolvingDecision-MakingWritten CommunicationVerbal CommunicationProfessionalism

Certifications & Qualifications

CFEAHFICPC

Industry Keywords

Medicaid InvestigationsComplianceAuditCross-Functional TeamsOperational Concerns

About the role

Key responsibilities & impact

Lead investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and compliance concerns
Manage day-to-day investigative workflows
Support staff development
Ensure investigations are conducted thoroughly, consistently, and in alignment with organizational standards and regulatory expectations
Translate investigative priorities into clear team direction
Monitor case progress
Identify risks
Elevate significant findings to leadership and stakeholders as appropriate
Balance quality, timeliness, and accountability in a highly sensitive environment

Requirements

What you’ll need

Minimum of two years of experience in health care fraud, waste, and abuse investigations, special investigations, compliance, audit, or a related field
Minimum of 5 years of investigative work experience
3+ years of leadership experience managing or coordinating investigative teams, workflows, and complex case activity
Strong analytical, problem-solving, and decision-making skills
Strong written and verbal communication skills, including the ability to summarize complex findings clearly
Ability to manage sensitive information with professionalism and discretion
Experience working across cross-functional teams in a regulated environment
Knowledge of investigative practices, documentation standards, and risk-based decision-making
Bachelor's degree in criminal justice, finance, business administration, or a related field
CFE, AHFI, or CPC certification preferred
Experience with Medicaid investigations and regulatory requirements preferred
Advanced analytical skills preferred
Ability to apply critical thinking and sound judgment to complex issues preferred
Strong ability to think innovatively and develop solutions to improve efficiency, quality, and team performance preferred

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being