Director, Special Investigations Unit

CVS Health•Hartford, CT

1d•Onsite

About The Position

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.

Requirements

10 or more years of experience in leading healthcare fraud investigative teams
Experience with litigation and criminal or civil investigations in a leadership capacity
Excellent writing skills with an ability to draft, edit, and analyze investigative findings, reports, and claim data.
Excellent public speaking skills

Nice To Haves

Accredited Healthcare Fraud Investigator [AHFI] and/or Certified Fraud Examiner [CFE]

Responsibilities

Oversight of multiple teams within the Special Investigations Unit, including Managers, Investigators, and investigative program management.
Program management of SIU policies, procedures, and practices ensuring compliant and efficient workflows.
Provides guidance to and ensures training for Managers and investigators regarding obtaining evidence, sufficiency of evidence, investigative interviews, and other investigatory techniques and practices.
Coordinates with state and federal law enforcement regarding matters under investigation
Identifies potential investigative issues, subjects, and targets.
Provides guidance on investigative and litigation strategies and issues; troubleshoots with staff to identify solutions.
Develops expertise in applicable laws, rules, regulations, and other standards related to investigative procedures and advises on the application of federal and state laws governing fraud, waste, and abuse.
Communicates with various internal and external stakeholders, including representatives from state and federal government and the healthcare industry.
Maintains effective oversight of investigative activity ensuring timeliness and quality.