Manager, Special Investigations Unit

CVS Health•Washington, DC

3d•$54,300 - $159,120

About The Position

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.

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

Nice To Haves

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

Responsibilities

Leading investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and/or compliance concerns.
Managing day-to-day investigative workflows.
Supporting the development of staff.
Ensuring investigations are conducted thoroughly, consistently, and in alignment with organizational standards and regulatory expectations.
Translating investigative priorities into clear team direction.
Monitoring case progress.
Identifying risks.
Elevating significant findings to leadership and stakeholders as appropriate.