Manager, Special Investigation

CVS Health Job Opportunity

At CVS Health, 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 reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary : Oversees corporate activities related to the prevention, investigation, and prosecution of health care fraud to recover lost funds. Responsible for compliance with state and federal regulations mandating the reporting of corporate fraud-related activities and the preparation of the Corporate Anti-Fraud Plan.

What You Will Do :

• Leads a team of investigators and analysts to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred.
• Leads a team in the planning and execution of investigations of acts of healthcare 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 basis.
• Manages workload of their team to ensure equitable distribution and exposure to wide range of cases to match current skills and development needs.
• Assesses training needs and works with SIU Director on development plans for team members.
• Develops and maintains close working relationships with federal, state, and local law enforcement agencies in the investigation and prosecution of acts of healthcare fraud and abuse.
• Participates in state meetings.
• Ensures compliance with contractual requirements.
• Coordinates and collaborates with program integrity 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 :

Preferred Qualifications :

Education :

Bachelor's degree preferred / specialized training / relevant professional qualification.

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is : $54,300.00 - $159,120.00

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 :

We anticipate the application window for this opening will close on : 09 / 28 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer.