If you know how to follow the money, build a clean case file, and communicate with law enforcement without getting lost in the weeds, this role is for you. You’ll investigate suspected healthcare fraud and abuse, support legal review, and help protect members and taxpayer dollars.
About CVS Health (Aetna SIU)
CVS Health is one of the nation’s leading health solutions companies, focused on making care more connected, convenient, and compassionate. The Aetna Special Investigations Unit (SIU) works to prevent, investigate, and support prosecution of healthcare fraud, waste, and abuse while improving controls and compliance.
Schedule
- Fully remote
- Full-time: 40 hours per week
- Travel required as needed for legal proceedings (depositions, arbitrations, etc.) and quarterly state meetings
What You’ll Do
⦁ Conduct investigations into suspected healthcare fraud, waste, and abuse to prevent improper payments and recover funds
⦁ Communicate with federal, state, and local law enforcement when cases move toward prosecution
⦁ Gather evidence using available technology and internal systems, supporting allegations with documentation
⦁ Research and prepare cases for clinical and legal review
⦁ Document all case activity in the tracking system, meeting required timelines
⦁ Make internal and external referrals and complete required deconflictions within established timeframes
⦁ Provide input on monitoring controls and fraud-related risk within business units
⦁ Deliver education and deterrence programs to reduce fraud losses
⦁ Manage outside vendors and resources cost-effectively when investigations require support
⦁ Attend and present at quarterly state meetings
What You Need
⦁ 1+ year of experience working with Medicaid
⦁ 3+ years in healthcare fraud, waste, and abuse investigations and/or audits
⦁ Strong research skills with the ability to identify and use multiple information sources
⦁ Experience using Microsoft Word, Excel, and Outlook
⦁ Experience using database search tools and online research resources
⦁ Ability to use internal company systems to obtain electronic documentation
⦁ Comfort traveling and participating in legal proceedings when required
⦁ Bachelor’s degree preferred, or Associate’s degree plus three additional years of related FWA investigation/audit experience
Benefits
⦁ Pay range: $46,988.00 to $122,400.00 (based on experience, location, and qualifications)
⦁ Eligible for bonus, commission, or short-term incentive programs (in addition to base pay)
⦁ Affordable medical plan options and 401(k) with company match
⦁ Employee stock purchase plan eligibility
⦁ No-cost wellness programs plus confidential counseling and financial coaching
⦁ Paid time off, flexible schedules, family leave, tuition assistance, and other benefits based on eligibility
Application window is expected to close January 10, 2026. If you’re qualified, don’t wait until the last week.
This is one of those roles where being sharp, thorough, and consistent gets noticed fast.
Happy Hunting,
~Two Chicks…