Senior Analyst, Investigations

Senior Analyst, Investigations

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 Analyst, Investigations at Aetna International plays a pivotal role in safeguarding the organization against fraud, waste, abuse (FWA), and compliance violations. This position is embedded within the International Special Investigations Unit (ISIU) and is designed to lead complex investigations into high-risk and sensitive matters that may compromise the integrity of the organization's operations and claims processes.

Core Responsibilities :

• Investigative Leadership : Conducts thorough investigations into suspected fraud, misconduct, or compliance breaches. These include analyzing billing and coding practices, verifying document authenticity, and identifying false claims or improper billing.
• Data-Driven Analysis : Utilizes advanced data analysis tools to detect patterns, anomalies, and trends that signal potential fraudulent activity. This includes mining claims data and leveraging forensic techniques to build evidence-based cases.
• Reporting & Documentation : Produces comprehensive investigative reports that summarize findings, outline evidence, and recommend actions such as disciplinary measures, restitution, or legal proceedings. These reports are shared with internal stakeholders and, when necessary, external regulatory bodies.
• Compliance Monitoring : Participates in audits and policy reviews to identify areas of non-compliance. Provides actionable recommendations to strengthen internal controls and mitigate risk.
• Cross-Functional Collaboration : Works closely with legal, compliance, internal audit, HR, and other departments to gather information, share findings, and support the investigative process. This collaboration ensures a holistic approach to risk management and resolution.
• Technology Integration : Advises on the selection and implementation of innovative technologies and forensic tools to enhance investigative efficiency and accuracy.
• Training & Awareness : Contributes to the development and delivery of training programs aimed at educating employees on fraud prevention, compliance obligations, and reporting mechanisms.

Strategic Impact : This role is critical to Aetna International's commitment to regulatory compliance and financial integrity. By proactively identifying and addressing FWA risks, the Sr Analyst helps protect the organization's reputation, ensures adherence to contractual and legal obligations, and supports global client commitmentsespecially in high-stakes international claims environments.

Required Qualifications :

Preferred Qualifications :

Education :

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is : $46,988.00 - $122,400.00

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 : 12 / 12 / 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.