CVS Health
Senior Investigator, Special Investigations Unit (SIU) - Must reside in Oklahoma
$47K–$92K
OK - Work from home · Remote · Senior · Full-time · Posted Oct 5, 2026
- Experience
- 2–5 years investigative experience in healthcare fraud and abuse matters; alternatively, the education section allows 5+ years of working health care fraud, waste and abuse investigations in lieu of a bachelor's degree.
- Education
- Bachelor's degree or equivalent experience (5+ years of working health care fraud, waste and abuse investigations).
About the job
Conduct complex healthcare fraud and abuse investigations, analyze claims, develop cases for review and prosecution, and support recovery of funds lost to aberrant billing.
What you'll do
- Investigate suspected healthcare fraud and abuse, including Medicaid claims, using research and claims-data analysis.
- Prepare cases for clinical and legal review; collaborate with Medical Directors and law enforcement, and communicate findings to providers and stakeholders.
- Guide junior investigators, document case activity, and support case outcomes and recovery of funds.
What they ask for
- Must reside in Oklahoma.
- 2–5 years of investigative experience in healthcare fraud and abuse matters.
- Working knowledge of medical coding, including CPT, HCPCS, and ICD10.
- Proficiency in Microsoft Office and advanced Excel skills, including pivot tables; ability to travel up to 10%.
Nice to have
- Medicaid/Medicare investigation experience and knowledge of applicable rules and regulations.
- CFE or AHFI credential; knowledge of complex clinical issues.
Pay
$46,988.00 - $91,800.00 (base pay range; posting describes this as the base hourly rate or base annual full-time salary and does not specify currency)
Tools
CPT, HCPCS, ICD10, Microsoft Office, Excel, Power BI
Model-written summary · the original posting is authoritative