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Fraud Waste and Abuse - Sr. Analyst at CVS Health - ApplyBlast

Fraud Waste and Abuse - Sr. Analyst

CVS Health

4 months ago

3.2 on Glassdoor

Arizona

Onsite

Full Time

Senior

0 applicants

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About this role

The Sr. Analyst, Fraud, Waste, and Abuse at CVS Health detects, investigates, and refers incidents of financial abuse within healthcare services. This role involves reviewing claims data, determining correct coding, and collaborating with legal and compliance departments to prevent inappropriate billing. The candidate will assist in training internal staff and monitoring reports to identify aberrant billing patterns.

Responsibilities

Review claims data to identify aberrant billing patterns
Investigate and triage internal and external fraud complaints
Refer suspected fraud cases to state regulatory agencies
Participate in prepayment reviews against medical records
Maintain QuickBase database of all fraud cases

Skills

Qualifications

CPC CertificationAssociate's DegreeHigh School Diploma

About CVS Health

cvshealth.com

Headquarters

Woonsocket, Rhode Island, United States

Company Size

10001+ employees

Founded

1963

View Profile

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.