Investigator, Special Investigation Unit (Must reside in West Virginia)

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: - This position is a remote position but West Virginia residency is required. - Conducts investigations to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud, waste, and abuse. Also reports suspected fraud, waste, and abuse to state and federal agencies as required by law and regulation. What you will do: - 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, bo...