CVS Pharmacy, Inc.Hiring

Special Investigation Unit Lead Review Analyst II

  • Remote, United States
  • Full-time
  • Mid-level
  • Posted 9 days ago
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In one line

Analyst role on a fraud unit, mining claims data to spot possible healthcare fraud and turn it into leads for investigators.

About the role

Work sits in the lead development stage, where billing patterns get checked before a case is opened. Findings are summarized for unit leadership, who decide whether to escalate, monitor or close.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, United States
Seniority
Mid-level
Employment
Full-time
Skills
CPT, HCPCS, ICD, DRG, NDC, Data mining, Claims analysis
Posted
20 Oct 2026
Last checked
29 Oct 2026

What you will do

  • Mine claims databases and reporting tools for possible fraud leads.
  • Check spike analyses, utilization trends and outlier reports for odd billing.
  • Review provider, member, equipment, transport and facility billing.
  • Analyze CPT, HCPCS, ICD, DRG and NDC codes plus modifiers and reimbursement trends.
  • Research public records, licensing boards and sanctions lists.
  • Write lead summaries with allegations, evidence and risk indicators.

What they look for

  • Strong analytical skills and healthcare claims expertise.
  • Ability to turn complex data into clear investigative leads.
  • Knowledge of CMS rules and regulatory requirements.
  • Experience with quantitative and qualitative claims analysis.
  • Comfort presenting recommendations to leadership.

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Questions about this job

Is this job fully remote, and from where?

Yes. The posting lists Special Investigation Unit Lead Review Analyst II as a remote role for candidates in the United States.

What does this job pay?

No pay range is stated in the posting.

What experience is needed?

It is a mid-level role. The posting asks for: strong analytical skills and healthcare claims expertise; ability to turn complex data into clear investigative leads; knowledge of CMS rules and regulatory requirements. Skills it names include CPT, HCPCS, ICD, DRG.

How do I apply with Keywordise AI?

Click Apply with Keywordise AI, create an account and upload your CV. Your CV and cover letter are written for this job from what you have really done, then Keywordise applies for you. Trial: 7 days, no card.

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