Special Investigations Unit (SIU) Senior Investigator (Fully Remote) at CVS Health in Boise, Idaho, United States Job Description Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary: As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are national in scope, complex cases involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes - Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business - Researches and prepares cases for clinical and legal review - Documents all appropriate case activity in case tracking system - Facilitates feedback with providers related to clinical findings - Initiates proactive data mining to identify aberrant billing patterns - Makes referrals, both internal and external, in the required timeframe - Facilitates the recovery of company and customer money lost as a result of fraud matters - Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators. - Assists Investigators in identifying resources an To view full details and how to apply, please login or create a Job Seeker account
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