Experienced Full Stack Healthcare Fraud Manager – Web & Cloud Application Development, Data Analysis, and Compliance Oversight

About Us

CVS Health is a leading healthcare company that is dedicated to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose is to bring our heart to every moment of your health, and we strive to make healthcare more personal, convenient, and affordable. At CVS Health, we believe that our employees are the key to achieving our mission, and we are committed to creating a supportive and forward-thinking work environment that fosters growth, innovation, and collaboration.

Job Summary

We are seeking an experienced Healthcare Fraud Manager to lead and oversee a team of investigators in our efforts to identify, prevent, and mitigate healthcare fraud, waste, and abuse. This role involves not only directing fraud detection and investigation activities but also developing strategies to minimize fraud risks, ensuring compliance with regulatory standards, and achieving operational productivity goals. If you are a strong leader with a passion for healthcare fraud prevention and a commitment to excellence, we encourage you to apply for this exciting opportunity.

Key Responsibilities

• Provide leadership, guidance, and support to a team of investigators, fostering a collaborative and productive work environment.
• Direct and oversee all fraud detection activities and investigations, ensuring alignment with organizational objectives and compliance standards.
• Stay informed on the latest fraud schemes and trends, adapting strategies and responses as needed to address new threats effectively.
• Work closely with investigative management and directors, sharing insights and aligning on fraud prevention and mitigation strategies.
• Create and implement strategies to proactively address and minimize fraud risks.
• Monitor team productivity and ensure investigative processes meet organizational productivity goals.
• Communicate findings, recommendations, and strategies effectively to senior leadership and relevant stakeholders.
• Ensure compliance with regulatory requirements and maintain standards across all investigation and fraud prevention activities.
• Develop and mentor team members, providing opportunities for professional growth and development.
• Foster a culture of continuous improvement and innovation within the team.

Essential Qualifications

To be successful in this role, you will need to possess the following essential qualifications:

• 7-10 years of experience in fraud investigations within the healthcare sector.
• Strong analytical and problem-solving skills with experience in data analysis and fraud detection.
• In-depth knowledge of healthcare fraud schemes, regulatory standards, and compliance requirements.
• Excellent communication and leadership skills.

Preferred Qualifications

While not required, the following qualifications would be beneficial for this role:

• Medicare and Medicaid investigative experience.
• Team leadership experience.
• Education: Bachelor's degree in Criminal Justice or related field or equivalent professional work experience.

Career Growth Opportunities and Learning Benefits

At CVS Health, we are committed to helping our employees grow and develop their careers. As a Healthcare Fraud Manager, you will have access to a range of learning and development opportunities, including:

• Training and development programs to enhance your skills and knowledge in healthcare fraud prevention and investigation.
• Opportunities for professional growth and advancement within the company.
• Access to industry-leading tools and technologies to support your work.
• A collaborative and supportive work environment that fosters innovation and creativity.

Work Environment and Company Culture

As a remote-based Healthcare Fraud Manager, you will have the flexibility to work from home and enjoy a range of benefits, including:

• A competitive salary and bonus structure.
• A comprehensive benefits package, including medical, dental, and vision insurance.
• A 401(k) retirement savings plan and employee stock purchase plan.
• A fully-paid term life insurance plan and short-term and long-term disability benefits.
• A range of paid time off and holidays.
• A commitment to diversity, equity, and inclusion.

Compensation, Perks, and Benefits

We offer a competitive salary and bonus structure, as well as a comprehensive benefits package, including:

• A competitive salary range of $54,300.00 - $159,120.00.
• A bonus structure that rewards performance and achievement.
• A comprehensive benefits package, including medical, dental, and vision insurance.
• A 401(k) retirement savings plan and employee stock purchase plan.
• A fully-paid term life insurance plan and short-term and long-term disability benefits.
• A range of paid time off and holidays.

How to Apply

If you are a strong leader with a passion for healthcare fraud prevention and a commitment to excellence, we encourage you to apply for this exciting opportunity. Please submit your application through our website, and we will review your qualifications and experience. We look forward to hearing from you!