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.
This position conducts high-level, complex analysis of dental providers and practices to effectively pursue the prevention, investigation, and prosecution of fraud, waste, and abuse. The role routinely handles sensitive or high-profile cases of national scope, collaborates with the dental network to provide meaningful evidence for corrective action, and works closely with federal, state, and local law enforcement agencies.
Responsibilities
- Conduct high-level, complex analysis of dental providers and practices to prevent, investigate, and prosecute fraud, waste, and abuse
- Collaborate with the dental network, providing meaningful evidence of fraud, waste, and abuse to support corrective action
- Handle sensitive or high-profile cases, including those national in scope
- Investigate to prevent payment of fraudulent activities
- Research and prepare cases for clinical, legal, and leadership review
- Document all appropriate case activity in the case tracking system
- Make referrals, both internal and external, within required timeframes
- Communicate and cooperate with federal, state, and local law enforcement agencies to assist in investigation and prosecution
- Provide testimony during civil and criminal proceedings with a high level of knowledge and expertise
- Give presentations to internal and external customers regarding dental matters
- Provide input regarding controls for monitoring fraud, waste, and abuse related issues within business units
- Maintain open communication with constituents within and external to the company
Requirements
- 3–5 years of healthcare fraud investigations experience
- Experience with Microsoft Word, Excel, and Outlook; open-source database search tools; social media and internet research
- Ability to travel for business purposes and legal proceedings
- Proficient in data analysis and research
- Knowledge of medical terminology
Qualifications
Preferred
- Certification from the Association of Certified Fraud Examiners (CFE) or accreditation from the National Health Care Anti-Fraud Association (AHFI)
- Bilingual in English/Spanish
- Strong verbal and written communication skills
- Strong customer service skills
- Knowledge of Aetna's policies and procedures
- Ability to interact with different groups of people at different levels
- Ability to utilize company systems to obtain relevant electronic documentation
- Clinical or FWA dental experience
Education
Bachelor's degree in Criminal Justice, Biological Science, Law, Healthcare Administration, or Health Information Management — or equivalent experience.
Pay
The typical pay range for this role is $46,988.00 – $112,200.00 per year (base annual full-time salary). The actual base salary offer will depend on 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.
Benefits
This full-time position is eligible for a comprehensive benefits package including medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility. Additional details are provided during the application process and on Benefits Moments.
Schedule
Full-time, 40 hours per week. On-site in Jefferson City, Missouri.
Job ID: 86540416 · Application window closes 10/31/2026