Senior Investigator, Special Investigations Unit

CVS Health

. Conduct high-level, complex analysis of dental providers and practices to prevent, investigate, and prosecute Fraud, Waste and Abuse .

Posted 9/17/2026full-timeHartford • Alabama • United StatesSenior💰 $46,988 - $112,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare fraud investigations, data analysis, and research, with strong communication skills to collaborate effectively with law enforcement and present findings. Proficient in utilizing technology and systems for case documentation and analysis.

Highest-signal resume keywords

Healthcare Fraud Investigations ExperienceData Analysis ProficiencyMedical Terminology KnowledgeCertification from CFE or AHFIBilingual in English/Spanish

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisResearchCase DocumentationFraud PreventionLegal Proceedings PreparationOpen Source Database SearchMicrosoft WordMicrosoft ExcelMicrosoft OutlookClinical or FWA Dental Experience

Soft Skills

Strong Verbal CommunicationStrong Written CommunicationCustomer Service SkillsInterpersonal Skills

Tools & Technologies

Case Tracking SystemSocial Media Research ToolsInternet Research Tools

Certifications & Qualifications

Certified Fraud Examiner (CFE)Accreditation from AHFI

Industry Keywords

FraudWasteAbuseDental NetworkAetna Policies and ProceduresHealthcare AdministrationCriminal JusticeBiological ScienceHealth Information Management

Tech Stack

Tools & technologies

Open Source

About the role

Key responsibilities & impact

Conduct high-level, complex analysis of dental providers and practices to prevent, investigate, and prosecute Fraud, Waste and Abuse
Collaborate with Dental Network to provide evidence supporting corrective action
Handle sensitive, high-profile, and nationally scoped cases
Investigate to prevent payment of fraudulent activities
Research and prepare cases for clinical, legal, and leadership review
Document case activity in the case tracking system
Make internal and external referrals within required timeframes
Communicate and cooperate with federal, state, and local law enforcement agencies
Provide expert testimony during civil and criminal proceedings
Give presentations to internal and external customers regarding dental matters
Provide input on controls for monitoring Fraud, Waste and Abuse issues
Maintain open communication with internal and external constituents

Requirements

What you’ll need

3-5 years of healthcare fraud investigations experience
Experience with Microsoft Word, Excel, and Outlook products
Experience with open source database search tools, social media and internet research
Ability to travel for business purposes and legal proceedings
Proficient in data analysis and research
Knowledge of Medical Terminology
Credentials such as certification from the Association of Certified Fraud Examiners (CFE) or accreditation from the National Health Care Anti-Fraud Association (AHFI) preferred
Bilingual in English/Spanish preferred
Strong verbal and written communication skills
Strong customer service skills
Knowledge of Aetna's policies and procedures
Ability to interact with different groups of people at different levels
Ability to utilize company systems to obtain relevant electronic documentation
Clinical or FWA Dental experience preferred
Bachelor's degree in Criminal Justice, Biological Science, Law, Healthcare Administration, or Health Information Management or equivalent experience

Benefits

Comp & perks

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