Senior Analyst, Special Investigation Unit

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.

The Senior RFI Analyst within the Special Investigations Unit (SIU) plays a key role in supporting fraud, waste, and abuse investigations by managing and responding to Requests for Information (RFIs) from regulatory agencies, law enforcement, and internal stakeholders. This position ensures timely, accurate, and compliant delivery of sensitive data and documentation across multiple lines of business and jurisdictions. The analyst collaborates closely with investigative teams, legal, compliance, and operational departments to maintain transparency and accountability in all RFI-related activities.

In addition to core responsibilities, the Senior RFI Analyst will support Training , Quality , and Program Integrity (PI) initiatives by pulling and analyzing relevant data, identifying trends, and contributing to the development of best practices. The analyst will also provide leadership support to the Manager by assisting with team coordination, reporting, and strategic planning efforts.

Required Qualifications

5+ years of experience in healthcare investigations, compliance, or data analysis (or equivalent professional experience)

Strong understanding of PHI / PII handling and regulatory requirements (e.g., HIPAA, CMS, state-specific guidelines)

Excellent written and verbal communication skills

Proficiency in Microsoft Excel, SharePoint, and case management systems

Ability to work independently and collaboratively in a fast-paced environment

Experience supporting training, quality, or process improvement efforts

Preferred Qualifications

Experience working with Medicaid and Medicare programs

Familiarity with state-specific fraud investigation protocols (e.g., Texas OIG, Florida AHCA)

Prior experience in a SIU or regulatory response role

Knowledge of claims processing, provider contracting, and credentialing workflows

Project management or process improvement experience

Education

Bachelor's degree in a relevant field such as Criminal Justice, Healthcare Administration, Business, or a related discipline. Equivalent professional experience may be considered in lieu of a formal degree.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is :

$46,988.00 - $112,200.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range 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 all 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 access and many other benefits depending on eligibility.

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We anticipate the application window for this opening will close on : 11 / 13 / 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. 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.