CVS Health
Senior Investigator, Special Investigations Unit (Aetna SIU)
$47K–$102K
Work At Home-Florida +46 · Remote · Senior · Full-time · Posted Oct 22, 2026
- Location
- Work At Home-Florida
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Work At Home-Delaware - Experience
- 3+ years investigative experience in healthcare fraud and abuse matters; education may be a bachelor's degree or equivalent experience (3+ years of working health care fraud, waste and abuse investigations).
- Education
- Bachelor's degree or equivalent experience (3+ years of working health care fraud, waste and abuse investigations).
About the job
Conduct complex investigations into suspected healthcare fraud and abuse, including Medicaid claims, and support case referrals, recoveries, legal proceedings, and investigator training.
What you'll do
- Investigate suspected fraud and abuse, identify aberrant billing patterns, and prepare cases for clinical and legal review.
- Coordinate referrals and recoveries; cooperate with law enforcement and provide testimony or presentations as needed.
- Train and guide investigators, assist with investigative strategy, and serve as backup to the Team Leader.
What they ask for
- 3+ years investigative experience in healthcare fraud and abuse matters.
- Working knowledge of medical coding: CPT, HCPCS, ICD10.
- Advanced Microsoft Office Excel skills, including pivot tables.
- Ability to travel up to 10% (approximately 2–3 times per year, depending on business needs).
Nice to have
- Previous Medicaid/Medicare investigatory experience.
- CFE certification or AHFI accreditation.
Pay
$46,988.00 - $102,000.00 (base hourly rate or base annual full-time salary; the posting does not specify an ISO currency code).
Tools
CPT, HCPCS, ICD10, Microsoft Office, Excel
Model-written summary · the original posting is authoritative