Senior Investigator, Special Investigations Unit (Aetna SIU)

About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. 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.

Responsibilities

• Conducts high level, complex analysis of Dental Providers and Practices to effectively pursue the prevention, investigation and prosecution of Fraud, Waste and Abuse.
• Collaborates with Dental Network, providing meaningful evidence of Fraud, Waste and Abuse to support corrective action.
• Routinely handles cases that are sensitive or high profile, those that are national in scope.
• Investigates to prevent payment of fraudulent activities.
• Researches and prepares cases for clinical, legal and leadership review.
• Documents all appropriate case activity in case tracking system.
• Makes referrals, both internal and external, in the required timeframe.
• Communicates and cooperates with federal, state, and