Coordinator, Special Investigations Unit (Aetna SIU)

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.

Position Summary

Under the direction of the Triage Manager, effectively initiates the triage of incoming healthcare fraud, waste, and abuse referrals/leads received in the Special Investigations Unit (SIU) from various internal and external sources.

• Runs initial Case Set Up reports, and gathers additional information relevant to the case

• Documents the receipt of new incoming referrals/leads for tracking purposes and prepares referrals for transfer to either Level 2 Triage or to Investigative Teams

• Maintains clear, concise, accurate, and complete documentation in the case tracking application

• Efficiently utilizes available resources and technology while performing the referral triage function
Required Qualifications

• 1+ years claim processing and/or customer service experience and/or prior Medical Claim Analyst experience.

• 1+ years of SIU Analyst experience or demonstrated ability to handle multiple assignments competently, accurately, and efficiently.

• Experience HRP, GPS, and EPDB.

• Experience working in Microsoft Excel.
 

Preferred Qualifications
• Strong analytical and research skills.

• Independent worker who is proficient in researching information and utilizing all available resources.

• Self-managed decision-maker, who looks beyond the immediate problem for root cause.

• Clear verbal and written communication skills.

• Strong customer service skills.

• Ability to interact with various business partners and offer assistance on a timely basis.

• Proficient in Microsoft Word and Outlook and in the use of the Intranet/Internet to research information.

• Ability to utilize company systems to obtain relevant electronic documentation.

• Knowledge of Aetna's policies and procedures.
Education

• High School diploma, G.E.D. or equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

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 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/09/2025

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