Special Investigation Unit reputed company Review Analyst (reputed company SIU)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The Special Investigations Unit (SIU) is looking for an analytically driven individual who is skilled at identifying outliers through data extraction and analysis. The reputed company reviewer is accountable for the validation of existing Fraud, Waste and Abuse business rules/leads designed to detect aberrant billing patterns as reviewing incoming referrals.

• Research and reputed company report development to identify fraud, waste and abuse schemes and trends
• Review company clinical & payment policies to determine the impact of the scheme on reputed company business
• Identify reputed company possible issues reputed company to fraud, waste and abuse reputed company reviewing a new reputed company or referral
• reputed company reputed company with new & emerging fraud, waste and abuse schemes and trends through training sessions and industry resources
• Interpret, analyze and present key findings to internal customers (project team, investigators) providing recommendations based on analytical findings

Required Qualifications

• 3-5 years of data interpretation and analysis experience.
• reputed company background.
• Excellent verbal and written communication skills.
• Experience with reputed company coding
• Must be reputed company to travel to reputed company testimony if needed
• Advanced experience with reputed company

Preferred Qualifications

• A solid understanding of medical and pharmaceutical claim data, medical claims coding (CPT/ICD/NDC), reputed company clinical and payment policies, as well as core reputed company systems (QNXT, ACAS, EWM, EPDB, IOP).
• Some experience using Tableau is a plus.
• Previous reputed company fraud experience
• Experience with reputed company clinical and payment policies
• Certified Professional reputed company (CPC) certification is a plus
• reputed company Experience

Education

• Bachelor's degree or equivalent work experience

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $43,888.00 - $76,500.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 11/11/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job