HireFT
Browse JobsHow it worksPricingAboutSuccess Stories
    Back to jobs
    AE

    Aetna

    Healthcare

    Senior Investigator, Special Investigations Unit (Aetna SIU)

    Hartford-Farmington Ave Rogers, United StatesFull-time3–5 yrs experience$47k – $112.2kPosted 1w ago
    All Aetna jobs

    Job description

    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.

    Position Summary

    • Conducts high level, complex analysis of Dental Providers and Practices to effectively pursue the prevention, investigation and prosecution of Fraud, Waste and Abuse.
    • Collaboration with Dental Network, providing meaningful evidence of Fraud, Waste and Abuse to support corrective action.
    • Routinely handles cases that are sensitive or high profile, those that are national in scope.
    • Investigates to prevent payment of fraudulent activities.
    • Researches and prepares cases for clinical, legal and leadership review.
    • Documents all appropriate case activity in case tracking system.
    • Makes referrals, both internal and external, in the required timeframe.
    • Communicates and cooperates with federal, state, and local law enforcement agencies to assist in the investigation and prosecution.
    • Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings.
    • Gives presentations to internal and external customers regarding Dental matters.
    • Provides input regarding controls for monitoring Fraud, Waste and Abuse related issues within the business units.
    • Maintains open communication with constituents within and external to the company.

    Required Qualifications

    • 3-5 years of healthcare fraud investigations experience
    • Experience with Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research
    • Ability to travel for business purposes and legal proceedings
    • Proficient in data analysis and research
    • Knowledge of Medical Terminology

    Preferred Qualifications

    • Credentials such as certification from the Association of Certified Fraud Examiners (CFE) or an accreditation from the National Health Care Anti-Fraud Association (AHFI)
    • Bilingual in English/Spanish
    • Strong verbal and written communication skills.
    • Strong customer service skills.
    • Knowledge of Aetna's policies and procedures
    • Ability to interact with different groups of people at different levels.
    • Ability to utilize company systems to obtain relevant electronic documentation.
    • Clinical or FWA Dental experience

    Education

    • Bachelor's degree in Criminal Justice, Biological Science, Law, Healthcare Administration, or Health Information Management or equivalent experience.

    Anticipated Weekly Hours

    40

    Time Type

    Full time

    Pay Range

    The typical pay range for this role is:

    $46,988.00 - $112,200.00

    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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

    This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


    Additional details about available benefits are provided during the application process and on
    Benefits Moments.

    We anticipate the application window for this opening will close on: 10/31/2026

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

    Job details are sourced from the employer's original posting.

    Open job posting
    AE

    About the company

    Aetna

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    View all Aetna jobs
    Industry
    Healthcare
    Open roles
    319

    Interested in this role?

    Apply with HireFT

    Free to start — no card required.

    Your fit

    How well do you match?

    Sign in to see how your résumé lines up with this role.