Project Lead (Fraud) – Case Tracking – WFH US

Aetna

Wellsville Kansas

United States

None
(No Timezone Provided)

Job Description


CVS now a Fortune 4 company!

The Special Investigations Unit (SIU) is responsible for the detection, investigation & prevention of suspected cases of healthcare fraud. The Project Lead position resides within our Systems & Reporting team. The team is accountable for financial reporting, application development, metrics & investigative reporting support.

We are looking for a data-driven individual to oversee all aspects of our internal proprietary case tracking application.

Job responsibilities include:
- Administrator for our internal Case Tracker application - the repository for all information related to fraud, waste & abuse referrals and investigations
- Evaluate customer needs for the application; facilitate user group forum
- Responsible for intake, evaluation and prioritization of customer requests and application fixes
- Bridge the business and technical side by transforming business needs into requirements for the application developer
- Work with advisers from key functional areas to understand potential project impact on the organization, align project work, and execute activities accordingly - -- Develop release schedule and project manage the technical development work
- Develop operational & ad hoc reports to support management, SIU staff and compliance
- Present to internal/external customers, constituents and business partners
- Influence change or enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access.

This role can be Remote/WFH-US.

Required Qualifications
- Experience and understanding of relational databases & case tracking applications.
- Solid understanding of fraud, waste and abuse investigations
- Data interpretation and analysis experience
- 2+ years of project management experience
- Advanced experience in Excel
- Demonstrated ability to lead and effectively coordinate multiple projects simultaneously
- Excellent verbal and written communication skills

Preferred Qualifications
- Ability to read C# coding is a plus
- Experience with project management software
- Basic/Intermediate SQL and/or SAS coding experience

Education
Bachelor's degree or equivalent work experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Project Lead (Fraud) – Case Tracking – WFH US

Aetna

Wellsville Kansas

United States

None

(No Timezone Provided)

Job Description


CVS now a Fortune 4 company!

The Special Investigations Unit (SIU) is responsible for the detection, investigation & prevention of suspected cases of healthcare fraud. The Project Lead position resides within our Systems & Reporting team. The team is accountable for financial reporting, application development, metrics & investigative reporting support.

We are looking for a data-driven individual to oversee all aspects of our internal proprietary case tracking application.

Job responsibilities include:
- Administrator for our internal Case Tracker application - the repository for all information related to fraud, waste & abuse referrals and investigations
- Evaluate customer needs for the application; facilitate user group forum
- Responsible for intake, evaluation and prioritization of customer requests and application fixes
- Bridge the business and technical side by transforming business needs into requirements for the application developer
- Work with advisers from key functional areas to understand potential project impact on the organization, align project work, and execute activities accordingly - -- Develop release schedule and project manage the technical development work
- Develop operational & ad hoc reports to support management, SIU staff and compliance
- Present to internal/external customers, constituents and business partners
- Influence change or enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access.

This role can be Remote/WFH-US.

Required Qualifications
- Experience and understanding of relational databases & case tracking applications.
- Solid understanding of fraud, waste and abuse investigations
- Data interpretation and analysis experience
- 2+ years of project management experience
- Advanced experience in Excel
- Demonstrated ability to lead and effectively coordinate multiple projects simultaneously
- Excellent verbal and written communication skills

Preferred Qualifications
- Ability to read C# coding is a plus
- Experience with project management software
- Basic/Intermediate SQL and/or SAS coding experience

Education
Bachelor's degree or equivalent work experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.