Manager, Special Investigations Unit – Healthcare Fraud

Special Investigations Unit Manager

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 Manager of the Special Investigations Unit is responsible for leading investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and/or compliance concerns. This role manages day-to-day investigative workflows, supports the development of staff, and helps ensure investigations are conducted thoroughly, consistently, and in alignment with organizational standards and regulatory expectations.

This leader plays an important role in translating investigative priorities into clear team direction, monitoring case progress, identifying risks, and elevating significant findings to leadership and stakeholders as appropriate. This position requires strong judgment, analytical rigor, and the ability to balance quality, timeliness, and accountability in a highly sensitive environment.

Required Qualifications:

• 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

Preferred Qualifications:

• CFE, AHFI, or CPC certification
• Experience with Medicaid investigations and regulatory requirements
• Advanced analytical skills
• 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

Education:

• Bachelor's degree in criminal justice, finance, business administration, or a related field

Anticipated Weekly

Hours:

40

Time Type:
Full time

Pay Range: $54,300.00 - $

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 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.

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