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 Fraud analytics team is looking for an Informatics clinical consultant who is skilled at utilizing healthcare claims data to identify outliers.  The ideal candidate retrieves, organizes, and performs analysis on healthcare data and also works with the team to develop, validate and deploy business rules indicative of FWA or payment integrity. This position requires extensive knowledge of healthcare claims and will work on identifying opportunities and delivering clinical/coding insights with internal and external teams.

Collaborates with Program Manager, Decision Scientists, and various other stakeholders to achieve operational and financial objectives. Needs to be able to work well independently, initiate strategic solutions, manage projects, and work collaboratively with the program team.

Required Qualifications

• Minimum 5 yrs. in Fraud, Waste or Abuse (or Payment Integrity)

• 5+ years’ experience in clinical coding or consulting 

• Certification in Professional Coding

Preferred Qualifications

• Experience in SQL or other programming languages

• Demonstrates strong ability to communicate clinical concepts and implications to business partners

• Ability to work independently

• Strong analytical and research skills

• Proficient in researching information and identifying information resources

• Detail-oriented

Education

• Preferred Bachelor’s degree or five years of equivalent experience in the industry. Master's degree preferred.

Pay Range

The typical pay range for this role is:

$79,310.00 - $173,040.00

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 jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/30/2024

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