Senior Analyst Investigations- Fully Remote

The Senior Analyst for Collaborative fraud, waste, and abuse (cFWA) program functions as part of the Safety Quality Management team.
cFWA is the designated unit responsible for certain core FWA detection, correction, and prevention activities.
This position is responsible for detecting, investigating and resolving instances of potential FWA, which may include, but is not limited to, investigations of medical professionals, pharmacies, beneficiaries or plan members including theft or misappropriation of services.The Senior Analyst is expected to investigate incidents and lead and develop investigative action plans.
The Senior Analyst may work incidents that require more specialized business processes and systems knowledge such as enrollment, coordination of benefits or pharmacy contracting.
This may include working with internal business partners to collect further information and coordinating investigation activities with Federal and/or state authorities.
Working in collaborative, cross functional, client facing environment, the Senior Analyst must be curious and intuitive as well as being comfortable presenting facts, findings and outcomes of investigations.The Senior Analyst will also utilize data analysis reports as part of FWA investigations to determine the scope of FWA.The Senior Analyst may be responsible for assisting in responding to outside requests for further information from state or Federal agencies and/or subpoenas as well as from the clients enrolled.
The Senior Analyst may be responsible for tracking of pharmacy audits completed by other departments, entering data about those audits as new cases, and making referrals to outside agencies about the results of audits as needed.The Senior Analyst conducts interviews, collects supportive data, assists in the development of suggested action plans, creates internal/external summary reports, and makes final determinations or suggestions for FWA cases in reaching closure and resolution.
Upon a determination of misconduct, the Senior Analyst sends referrals to the client and/or Federal and/or state authorities within regulatory guidelines.Manage new projects, processes and work instructions.
Collaborate with other areas to ensure outcomes of the program are being achieved.Pay RangeThe typical pay range for this role is:
Minimum:
43,700Maximum:
97,400Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls.
The actual salary offer will take into account a wide range of factors, including location.Required Qualifications3-5 years PBM experience 1.
Capable of interacting with all levels of management and have the ability to anticipate and resolve issues before they escalate.
2.
Excellent oral and written communication skills.
3.
Ability to think critically and multi-task.
4.
Ability to work on highly sensitive and confidential matters with a high of degree professionalism and discretion.
5.
Organized, detail-oriented and able to handle a heavy workload.
6.
Ability to work independently and in a team atmosphere.
7.
Advanced knowledge of internal systems.
8.
Ability to conduct investigations with minimal direction from management 9.
Ability to effectively and efficiently respond to time sensitive requests from all levels and departments within and outside the organization.
11.
Knowledge of Microsoft Word and Excel required.
12.
Experience with data analysis using Tableau.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment.
Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsLicensed Pharmacy TechnicianCFE certification pharmacy health fraud experienceEducationPrefer Bachelors DegreeBusiness OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose:
Bringing our heart to every moment of your health.
This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.
Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose.
We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services.
We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Associated topics:
crime scene, detective, fingerprint, inspector, investigate, investigation, investigative, investigator