Senior Analyst, Investigations

Senior Analyst, Investigations

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

The Senior Analyst, Investigations at Aetna International plays a pivotal role in safeguarding the organization against fraud, waste, abuse (FWA), and compliance violations. This position is embedded within the International Special Investigations Unit (ISIU) and is designed to lead complex investigations into high-risk and sensitive matters that may compromise the integrity of the organization's operations and claims processes.

Core responsibilities include :

• Investigative leadership : Conducting thorough investigations into suspected fraud, misconduct, or compliance breaches.
• Data-driven analysis : Utilizing advanced data analysis tools to detect patterns, anomalies, and trends that signal potential fraudulent activity.
• Reporting & documentation : Producing comprehensive investigative reports that summarize findings, outline evidence, and recommend actions.
• Compliance monitoring : Participating in audits and policy reviews to identify areas of non-compliance.
• Cross-functional collaboration : Working closely with legal, compliance, internal audit, HR, and other departments to gather information, share findings, and support the investigative process.
• Technology integration : Advising on the selection and implementation of innovative technologies and forensic tools to enhance investigative efficiency and accuracy.
• Training & awareness : Contributing to the development and delivery of training programs aimed at educating employees on fraud prevention, compliance obligations, and reporting mechanisms.

This role is critical to Aetna International's commitment to regulatory compliance and financial integrity. By proactively identifying and addressing FWA risks, the Sr Analyst helps protect the organization's reputation, ensures adherence to contractual and legal obligations, and supports global client commitmentsespecially in high-stakes international claims environments.

Required qualifications include :

Preferred qualifications include :

Education : Bachelor's degree preferred / specialized training / relevant professional qualification / High School Diploma and equivalent experience.

Anticipated weekly hours : 40

Time type : Full time

Pay range : $46,988.00 - $122,400.00

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.