CVS Health
Special Investigation Unit Lead Review Analyst II (Aetna SIU)
$44K–$85K
FL - Work from home · Remote/Hybrid · Full-time · Posted Oct 19, 2026
- Experience
- 3+ years in one or more of the stated areas.
- Education
- Bachelor's degree or equivalent combination of education and experience.
About the job
Analyzes healthcare claims and related intelligence to identify, evaluate, and recommend action on potential fraud, waste, and abuse leads for the Special Investigations Unit.
What you'll do
- Mine and analyze medical and pharmacy claims, billing patterns, and investigative information to develop and validate FWA leads.
- Prepare lead summaries and present findings and recommendations on escalation, monitoring, or closure.
- Collaborate with investigative, clinical, legal, compliance, and business teams while following SIU and regulatory requirements.
What they ask for
- 3+ years of healthcare data analysis, SIU, claims analysis, auditing, payment integrity, or healthcare fraud experience.
- Strong analytical and critical-thinking skills, including identifying trends and anomalies.
- Experience interpreting large healthcare datasets and turning findings into actionable insights.
- Working knowledge of healthcare claims processing and coding methodologies; ability to travel up to 10%.
Nice to have
- Healthcare payer SIU experience; knowledge of Medicare, Medicaid, Commercial, or Marketplace programs.
- Experience with Tableau, Power BI, or equivalent analytical platforms; relevant fraud, healthcare investigation, or coding certification.
Pay
$43,888.00 - $85,068.00 USD base salary (base hourly rate or base annual full-time salary; posting does not specify which applies to this role)
Tools
Tableau, Power BI, CPT, HCPCS, ICD, DRG, NDC
Model-written summary · the original posting is authoritative