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About the Role

The Manager of the Special Investigations Unit leads investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and compliance concerns. This role manages daily investigative workflows, supports staff development, and ensures thorough, consistent investigations aligned with organizational standards and regulatory expectations. The leader translates investigative priorities into team direction, monitors case progress, identifies risks, and elevates significant findings to leadership.

Responsibilities

Leads investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and/or compliance concerns.
Manages day-to-day investigative workflows.
Supports the development of staff.
Ensures investigations are conducted thoroughly, consistently, and in alignment with organizational standards and regulatory expectations.
Translates investigative priorities into clear team direction.
Monitors case progress.
Identifies risks.
Elevates significant findings to leadership and stakeholders as appropriate.

Requirements

Minimum of two years of experience in health care fraud, waste, and abuse investigations, special investigations, compliance, audit, or a related field.
Minimum of 5 years of investigative work experience.
Experience leading or coordinating investigative teams, workflows, and complex case activity.
Strong analytical, problem-solving, and decision-making skills.
Strong written and verbal communication skills, including the ability to summarize complex findings clearly.
Ability to manage sensitive information with professionalism and discretion.
Experience working across cross-functional teams in a regulated environment.
Knowledge of investigative practices, documentation standards, and risk-based decision-making.
Ability to apply critical thinking and sound judgment to complex issues.
Strong ability to think innovatively and develop solutions to improve efficiency, quality, and team performance.

Skills

Analytical skills
Problem-solving skills
Decision-making skills
Written communication skills
Verbal communication skills
Critical thinking
Sound judgment
Innovative thinking

Location

Remote

Work Type

Full time

Experience Level

Manager

Education Level

Bachelor’s degree in criminal justice, finance, business administration, or a related field
CFE certification
AHFI certification
CPC certification

Salary/Compensations

$54,300.00 - $159,120.00

Benefits

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs

About the Company

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.
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.
We 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.

Equal Opportunity

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