Clinical Fraud Waste and Abuse - Senior Analyst - Investigations

CVS Health • Hyde Park Township, IL, United States • $200k - $250k / year • 5d ago

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

The Sr. Analyst works independently to provide support and accountability to the Pharmacy Audit organization in order to meet client and program needs. The Sr. Analyst is responsible for a variety of tasks ensuring the completion of Collaborativ FWA program deliverables, including: intake of new issues related to FWA; conducting quarterly data analysis to identify possible outliers in terms of usage, prescribing, and dispensing; triage identified cases to determine how best to handle and resolve identified issues; investigate and facilitate resolution of identified issues; meet regularly with FWA-affiliated departments, product owners, and clients to discuss issues and provide updates on activities; and respond to MEDIC requests. The Sr Analyst may also assist Manager and Snr Manager to effectively develop, implement and manage FWA product and oftentimes takes the lead on projects. The Sr Analyst will work with the Account Management, Corporate Security, Pharmacy Audit, Product Owners, and Safety and Monitoring teams to meet overall company and business unit objectives.

Required Qualifications

3 years PBM experience
1 year Healthcare FWA experience

Preferred Qualifications

Ability to prioritize and manage multiple demands and meet deadlines with strong detail orientation.
Excellent verbal and written communication skills.
Comfort level working with all levels of internal external customers.
Analytical abilities.
Ability to work independently or as part of a team.
Professional attitude.
Desired PC Office software including MS Access, Excel, Word, and internal databases such as RxClaim and RxNavigator, Medical vocabulary and drug knowledge.
PTCB certified.
Healthcare fraud certification.

Education
High School Diploma
Bachelors Degree Preferred

Pay Range

The typical pay range for this role is: $46,988.00 - $91,800.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including 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 listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/31/2024.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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