Senior Investigator, Special Investigations Unit – SIU

CVS Health

. Conduct high-level, complex investigations of suspected healthcare fraud and abuse .

Posted 9/15/2026full-timeRemote • Oklahoma • United StatesSenior💰 $46,988 - $91,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting complex healthcare fraud investigations, analyzing claims data, and collaborating with medical professionals. Proficient in regulatory compliance and effective communication of clinical findings.

Highest-signal resume keywords

Healthcare Fraud InvestigationData AnalysisMedical Coding KnowledgeMicrosoft Excel ProficiencyCFE or AHFI Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative ExperienceData MiningClaims Data AnalysisMedical Coding (CPT, HCPCS, ICD10)Proactive Research

Soft Skills

Strong Communication SkillsAnalytical AbilitySelf-StarterTraining and Guidance

Tools & Technologies

Microsoft OfficePower BISIU Tools

Certifications & Qualifications

CFEAHFI

Industry Keywords

MedicaidMedicareFraud and AbuseRegulatory ComplianceHealthcare Investigations

About the role

Key responsibilities & impact

Conduct high-level, complex investigations of suspected healthcare fraud and abuse
Investigate program-integrity matters involving aberrant Medicaid claims
Research subjects and related entities
Independently conduct proactive data mining using SIU tools
Analyze claims data to identify aberrancy, patterns, and schemes
Research and prepare cases for clinical and legal review
Collaborate with Medical Directors on clinical issues and medical-record questions
Document case activity and communications in the designated tracking system
Communicate clinical findings to providers
Adhere to regulatory requirements
Facilitate recovery of company and customer funds lost through aberrant billing
Train and guide new and junior investigators
Assist junior investigators with resources and investigative strategy
Serve as backup to the Team Leader as needed
Collaborate with federal, state, and local law-enforcement agencies on healthcare-fraud investigations and prosecutions
Present healthcare-fraud findings and FWA knowledge to internal and external stakeholders
Testify in civil and criminal proceedings
Develop professional presentations on healthcare fraud matters and enterprise FWA approaches
Recommend efficiency gains and provide input on FWA monitoring controls

Requirements

What you’ll need

Must reside in Oklahoma
2-5 years investigative experience in healthcare fraud and abuse matters
Working knowledge of medical coding, including CPT, HCPCS, and ICD10
Proficient in Microsoft Office
Advanced Excel skills, including pivot tables
Power BI skills
Self-starter who initiates research vital to investigations
Proficient in researching information and identifying new case resources
Ability to travel up to 10%
Medicaid/Medicare investigation experience preferred
Knowledge of applicable Medicaid/Medicare rules and regulations preferred
Association of Certified Fraud Examiners (CFE) or National Health Care Anti-Fraud Association (AHFI) credentials preferred
Knowledge and understanding of complex clinical issues preferred
Strong verbal and written communication skills
Strong analytical ability to analyze claims data from multiple perspectives
Bachelor's degree or equivalent experience (5+ years of working health care fraud, waste and abuse investigations)

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 in addition to base pay