Healthcare Fraud Manager - Lead Investigative Efforts in Fraud Detection and Prevention for Aetna's Special Investigation Unit (SIU)

Transforming Healthcare Through Integrity and Innovation

At CVS Health, we're driven by a singular purpose: to bring our heart to every moment of your health. As a leading healthcare organization, we're committed to making healthcare more personal, convenient, and affordable. Our Aetna division is seeking an experienced Healthcare Fraud Manager to lead our Special Investigation Unit (SIU) in identifying, preventing, and mitigating healthcare fraud, waste, and abuse. If you're a seasoned professional with a passion for investigative work and a commitment to excellence, we invite you to join our team.

About the Role

As a Healthcare Fraud Manager, you will play a critical role in leading a team of investigators in our SIU. You'll be responsible for developing and implementing strategies to minimize fraud risks, ensuring compliance with regulatory standards, and driving operational productivity. This is a remote opportunity with the flexibility to work from anywhere, while still being part of a collaborative and dynamic team.

Key Responsibilities

• Provide leadership, guidance, and support to a team of investigators, fostering a collaborative and productive work environment.
• Direct and oversee all fraud detection activities and investigations, ensuring alignment with organizational objectives and compliance standards.
• Stay informed on the latest fraud schemes and trends, adapting strategies and responses as needed to address new threats effectively.
• Work closely with investigative management and directors, sharing insights and aligning on fraud prevention and mitigation strategies.
• Create and implement strategies to proactively address and minimize fraud risks.
• Monitor team productivity and ensure investigative processes meet organizational productivity goals.
• Communicate findings, recommendations, and strategies effectively to senior leadership and relevant stakeholders.
• Ensure compliance with regulatory requirements and maintain standards across all investigation and fraud prevention activities.
• Develop and mentor team members, providing opportunities for professional growth and development.
• Foster a culture of continuous improvement and innovation within the team.

Qualifications and Requirements

Essential Qualifications

• 7-10 years of experience in fraud investigations within the healthcare sector.
• Strong analytical and problem-solving skills with experience in data analysis and fraud detection.
• In-depth knowledge of healthcare fraud schemes, regulatory standards, and compliance requirements.
• Excellent communication and leadership skills.
• Bachelor's degree in Criminal Justice or related field, or equivalent professional work experience.

Preferred Qualifications

• Medicare and Medicaid investigative experience.
• Team leadership experience.

What We Offer

At CVS Health, we're committed to supporting the well-being and growth of our colleagues. As a Healthcare Fraud Manager, you'll be eligible for a competitive salary, bonus opportunities, and a comprehensive benefits package, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Term life insurance, short-term and long-term disability benefits.
• Well-being programs, education assistance, and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) and paid holidays.

Career Growth and Development

As a Healthcare Fraud Manager, you'll have opportunities for professional growth and development within our organization. You'll be part of a dynamic team that's committed to staying ahead of the curve in healthcare fraud prevention and detection. Our culture encourages continuous learning, innovation, and collaboration, ensuring that you'll have the support and resources you need to succeed.

Our Culture and Work Environment

At CVS Health, we're committed to creating a work environment that's inclusive, collaborative, and supportive. Our Heart At Work Behaviors guide our interactions with colleagues, customers, and communities, and we're dedicated to fostering a culture that values diversity, equity, and inclusion. As a remote worker, you'll have the flexibility to work from anywhere, while still being connected to our team and culture.

Join Our Team

If you're a motivated and experienced professional looking to make a difference in healthcare, we encourage you to apply for this exciting opportunity. As a Healthcare Fraud Manager, you'll play a critical role in protecting the integrity of our healthcare system and ensuring that our members receive the care they need. Apply now and join our team of dedicated professionals who are bringing their heart to every moment of health.

We anticipate the application window for this opening will close on January 31, 2025. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.