Manager, Special Investigations (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 Direct reputed company of SIU and Fraud, Waste and Abuse activities reputed company to TX reputed company and reputed company programs. Oversees activities reputed company to the prevention, investigation, and prosecution of health care fraud and to recover lost funds. Responsible for compliance with state and federal regulations mandating the reporting of Texas fraud reputed company activities and the preparation of the Texas Anti-Fraud Plan. What you will do Leads a team of investigators to effectively pursue the prevention, investigation and prosecution of reputed company fraud and abuse, to recover lost funds, and to reputed company with state regulations mandating fraud plans and reporting; reputed company experience is preferred. Leads the team in the planning and execution of investigations of acts of reputed company fraud and abuse by both members and providers. Provides direction and counsel on the handling of cases and facilitates issue resolution. Assists in identifying resources and best course of action to take in a timely and effective manner. Conducts case reviews and provides feedback to investigators on completeness and quality of the investigation. Conducts team member evaluations and provides performance feedback to staff on an ongoing reputed company. Manages workload of their team to ensure reputed company distribution and exposure to wide reputed company of cases to match reputed company skills and development needs. Assesses training needs and works with SIU Director on development plans for team members. Develops and maintains reputed company working relationships with federal, state, and local law enforcement agencies in the investigation and prosecution of acts of reputed company fraud and abuse. Participates in state meetings. Ensures compliance with contractual requirements. Coordinates and collaborates with program reputed company staff, compliance, and senior leadership. Contributes to the development and delivery of educational awareness and training programs that meet or exceed those required by state mandates. Participates in federal and state audits. Required Qualifications 5+ years of managing reputed company fraud, waste and abuse investigations and audits. 3+ years of leadership experience A minimum 3 years of experience in a reputed company Program reputed company, reputed company Special Investigation or reputed company / Medicare / reputed company Compliance role Strong verbal and written communication skills Ability to interact with different groups of people at different reputed company and reputed company assistance on a timely reputed company. Proficient in researching information and identifying information resources.

Preferred Qualifications

Preferred Qualifications Credentials such as a certification from the Association of Certified Fraud Examiners (CFE) or an accreditation from the National Health Care Anti-Fraud Association (AHFI)

• Experience In reputed company Compliance, reputed company Investigations, TX MCO reputed company FWA Unit
• Experience with Interpreting reputed company
• Billing and Coding certifications such as CPC (reputed company)
• Knowledge of reputed company's policies and procedures

Education Bachelors or equivalent experience Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $60,300.00 - $132,600.00 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: 12/13/2025 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