UNKNOWN

FEED

The position plays a key role in identifying fraud risks, supporting program integrity efforts, and helping to prevent financial losses related to fraud, waste, and abuse. Directs complex investigations, including data analysis, interviews, and document review, to identify potential fraud, waste, and abuse, including NSA-related activity.

YEAR

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.Position SummaryThis individual contributor role supports complex investigations and contributes to organizational compliance with federal and state regulations. The position plays a key role in identifying fraud risks, supporting program integrity efforts, and helping to prevent financial losses related to fraud, waste, and abuse.Performs complex investigations related to healthcare fraud, waste, and abuse (FWA), with a focus on compliance with the No Surprises Act (NSA). This individual contributor role is responsible for analyzing healthcare data, conducting investigations, ensuring regulatory compliance, and supporting program integrity initiatives.Key Responsibilities<ul><li>Directs complex investigations, including data analysis, interviews, and document review, to identify potential fraud, waste, and abuse, including NSA-related activity.</li><li>Conducts investigations into suspected fraud, waste, and abuse associated with the No Surprises Act (NSA), including independent dispute resolutions.</li><li>Investigates dispute outcomes and identifies providers submitting non-NSA claims to CIDRE.</li><li>Prioritizes and manages cases to ensure timely, accurate, and compliant investigations.</li><li>Analyzes healthcare data and claims to identify patterns, trends, and anomalies indicative of fraud.</li><li>Supports risk mitigation efforts and ensures compliance with regulatory requirements, including NSA provisions.</li><li>Ensures investigative reports are accurate, complete, and compliant with legal and regulatory standards.</li><li>Develops and delivers training on fraud, waste, and abuse prevention, including NSA requirements.</li><li>Provides guidance and mentorship to team members during investigations.</li><li>Advises management on fraud trends, regulatory changes, and best practices.</li><li>Collaborates with internal partners and external stakeholders to support investigations.</li><li>Partners with law enforcement, as appropriate, to support investigation and prosecution efforts.</li><li>Maintains stakeholder communication and provides input on fraud risk controls.</li></ul>Required Qualifications<ul><li>5+ years of experience in healthcare fraud, waste, and abuse investigations or related program integrity functions</li><li>Experience analyzing healthcare claims data</li><li>Knowledge of healthcare regulatory requirements</li><li>Strong analytical, investigative, and problem-solving skills</li><li>Ability to manage multiple priorities and meet established timelines</li></ul>Preferred Qualifications<ul><li>Experience with the No Surprises Act (NSA)</li><li>Familiarity with CIDRE</li><li>Experience working with regulatory agencies or law enforcement</li><li>Certifications such as Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI)</li><li>Advanced knowledge of healthcare claims processing and billing practices</li></ul>Education<ul><li>Bachelor's degree or equivalent combination of education and experience</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$66,330.00 - $145,860.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.We anticipate the application window for this opening will close on: 07/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.

CVS Health Corp

Fraud, Waste & Abuse (FWA) Investigator - No Surprises Act (NSA)

Analysis Skills

Best Practices

Billing

Certified Financial Examiner (CFE)

Claims Processing

Data Analysis

Documentation Review

Establish Priorities

Federal Laws and Regulations

Fraud Investigation

Geography

Healthcare

Incentive Programs

Investigative Reports

Law Enforcement

Legal Standards

Maintain Compliance

Mentoring

Multitasking

National Security Agency (NSA)

People Management

Problem Solving Skills

Regulations

Regulatory Compliance

Regulatory Requirements

Risk Analysis

Risk Management

Safety/Work Safety

State Laws and Regulations

Time Management

Training/Teaching

Trend Analysis

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 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. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.

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. The SIU Senior Investigator conducts complex investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices. What you will do Routinely handles complex cases involving behavioral health or multi-disciplinary provider groups in a prepayment environment Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. Researches and prepares cases for clinical and legal review. Documents all appropriate case activity in case tracking system. Prepares and presents referrals, both internal and external, in the required timeframe. Facilitates the recovery of company lost as a result of fraud matters. Assists team in identifying resources and best course of action on investigations. Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings. Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud. Provides input regarding controls for monitoring fraud related issues within the business units. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required. Knowledge of CPT/HCPCS/ICD coding Knowledge and understanding of clinical issues. Experience and proficiency in Microsoft Word, Excel, and Outlook, Database search tools, and use in the Intranet/Internet to research information. Ability to effectively interact with different groups of people at different levels in any situation. Ability to utilize company systems to obtain relevant electronic documentation. Ability to travel and participate in legal proceedings, arbitrations, depositions, etc. Preferred Qualifications Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI), or have a minimum of three years Medicaid Fraud, Waste and Abuse investigatory experience. Billing and Coding certifications such as CPC (AAPC)and/or CCS (AHIMA) Knowledge of Behavioral Health policies and procedures. Experience working Behavioral Health fraud cases. Strong analytical and research skills using health care data. Strong communication and customer service skills. Proficient in researching information and identifying information resources. Education Bachelor's degree, or an Associate's degree, with an additional three years (3 years total) working on health care fraud, waste, and abuse investigations and audits required. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" rel="nofollow">https://jobs.cvshealth.com/us/en/benefits</a> We anticipate the application window for this opening will close on: 04/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Investigator, Special Investigations Unit (Aetna SIU)

Behavioral Health

Certified Coding Specialist (CCS)

Certified Professional Coder (CPC)

Communication Skills

Cross-Functional

Current Procedural Terminology (CPT)

Customer Support/Service

Documentation

Health Plan

Healthcare Common Procedure Coding System (HCPCS)

International Classification of Diseases (ICD)

Internet Research

Intranet

Legal

Legal Documents

Medicaid

Medical Coding

Microsoft Excel

Microsoft Outlook

Microsoft Word

Research Skills

Stock Purchase Plans

Willing to Travel

OTHER

Overview:
Company Overview: Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you’re ready to grow with the best, explore a career with us and make a difference.

Job Description:
Allied Universal® is hiring a Surveillance Investigator. The Surveillance Investigator will perform discreet mobile and stationary surveillance of a Claimant to confirm current activities and capabilities to assist with the administration of an insurance claim. <ul style="margin: 0px; padding: 0px; font-family: verdana;"><li style="margin: 0px 0px 0px 22px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_MSFontService, sans-serif;" aria-setsize="-1" data-leveltext="" data-font="Symbol" data-listid="15" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="115" data-aria-level="1">No office to go to - travel daily to cases in the field!<span style="margin: 0px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_EmbeddedFont, Verdana_MSFontService, sans-serif; color: #000000;" data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559685":700,"335559737":-20,"335559738":0,"335559739":0,"335559740":279}"> </li></ul><ul style="margin: 0px; padding: 0px; font-family: verdana;"><li style="margin: 0px 0px 0px 22px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_MSFontService, sans-serif;" aria-setsize="-1" data-leveltext="" data-font="Symbol" data-listid="15" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="116" data-aria-level="1">Opportunities for growth and career development<span style="margin: 0px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_EmbeddedFont, Verdana_MSFontService, sans-serif; color: #000000;" data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559685":700,"335559737":-20,"335559738":0,"335559739":0,"335559740":279}"> </li></ul><ul style="margin: 0px; padding: 0px; font-family: verdana;"><li style="margin: 0px 0px 0px 22px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_MSFontService, sans-serif;" aria-setsize="-1" data-leveltext="" data-font="Symbol" data-listid="15" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="117" data-aria-level="1">Must possess a valid driver's license with at least one year of driving experience<span style="margin: 0px; padding: 0px; font-size: 10pt; font-family: Verdana, Verdana_EmbeddedFont, Verdana_MSFontService, sans-serif; color: #333333;" data-ccp-props="{"134233117":false,"134233118":false,"201341983":0,"335559685":700,"335559737":-20,"335559738":0,"335559739":0,"335559740":279}"> </li></ul> RESPONSIBILITIES:<ul><li>Conduct independent investigations of insurance claims across a range of coverage types, including workers’ compensation, general liability, property and casualty, and disability</li><li>Utilize various surveillance techniques and equipment to monitor subjects covertly</li><li>Document and report observations, activities, and any relevant information in a clear and concise manner</li><li>Collaborate with other investigators and law enforcement agencies as needed to gather information and coordinate efforts</li><li>Maintain confidentiality and adhere to legal and ethical standards in conducting surveillance operations</li></ul>QUALIFICATIONS (MUST HAVE):<ul><li>High school diploma or equivalent</li><li>Post offer, must be able to successfully complete the Allied Universal Investigations' training/orientation course</li><li>Minimum of one (1) year of verifiable work experience, preferably involving investigations or other protective service-related field</li><li>Flexibility to work varied and irregular hours/days including weekends and holidays</li><li>Ability to type reports in Microsoft Word format with minimal grammatical and punctuation errors</li><li>Proficient in utilizing laptop computers, video cameras and cell phones</li><li>Capable of maintaining focus and multitasking effectively in a dynamic environment</li><li>Demonstrated ability to manage stressful situations with composure and professionalism</li><li>Ability to work in a very independent environment</li></ul>PREFERRED QUALIFICATIONS (NICE TO HAVE):<ul><li>Associate’s Degree or higher, preferably in Criminal Justice</li><li>Security/Loss Prevention experience</li><li>Military experience</li><li>Law enforcement experience</li><li>Prior insurance investigations experience</li><li>Prior educational or professional incident reporting and/or investigations experience</li></ul>BENEFITS:<ul><li>Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance</li><li>Seven paid holidays annually, sick days available where required by law</li><li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law</li></ul>

Closing:
Allied Universal® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.

Requisition ID:
2026-1598159

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>

Investigator Jobs in Pearl, MS

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Investigator Jobs in Pearl, MS

Fraud, Waste & Abuse (FWA) Investigator - No Surprises Act (NSA) CVS Health Corp

Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health Corp

Surveillance Investigator Allied Universal

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