Special Investigation Unit Lead Review Analyst Jobs

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 The Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

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 The Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

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 The Lead, Senior Decision Scientist serves as a strategic analytics and ideation leader supporting Payment Integrity Affordability initiatives with a primary focus on Fraud, Waste & Error (FWE) and Special Investigations Unit (SIU) programs. This role provides leadership and guidance to a team of Decision Scientists while driving the development, evaluation, and implementation of innovative opportunities that improve affordability outcomes and strengthen Payment Integrity capabilities. The Lead Decision Scientist is responsible for establishing analytical frameworks, managing ideation pipelines, defining success metrics, and identifying cross-functional opportunities that create enterprise value across Payment Integrity programs. Required Qualifications 7+ years of experience in healthcare analytics, Payment Integrity, Fraud, Waste & Error (FWE), Special Investigations, or related healthcare operations. 5+ years of experience leading analytical projects or providing technical leadership within a healthcare environment. Demonstrated experience working with healthcare claims platforms including ACAS, QNXT, HRP, or comparable systems. Experience using SAS, SQL, Python, R, or other analytical and statistical programming languages. Experience performing advanced data analysis, opportunity identification, trend analy

Investigator, Special Investigations Unit (Meritain Health) — 49 Locations. Apply via Workday.

Certified Professional Coder, Special Investigations Unit (Aetna SIU) — 48 Locations. Apply via Workday.

Behavioral Health Senior Investigator (BCBA), Special Investigations Unit (Aetna SIU) — CT - Hartford. Apply via Workday.

About Team : The Internal Audit team at Paytm comprises seasoned professionals with diverse skill sets and experience across different verticals like process audits, technology audits and forensics. The team focuses on implementing the approved audit plan, ensuring delivery of qualitative audits and conducting internal / special reviews while leveraging technology & data analytics and gauging key risks across business processes. Manager – Internal Audit (6–8 Years Exp) Role Overview: As a Manager, you will be a strategic partner to the business. You won’t just be "checking boxes"; you’ll be designing the audit framework for complex ecosystems like UPI, Wallet, and Lending. You will lead teams and interface directly with Senior Leadership. Key Responsibilities ●Audit Strategy: Develop and execute an annual risk-based audit plan focusing on high-growth business units. ● Stakeholder Management: Act as the primary point of contact for Department Heads, explaining risk implications and negotiating remediation plans. ● Process Engineering: Evaluate the effectiveness of internal controls ($ICFR$) and suggest automation to move from manual testing to continuous monitoring. ● Team Leadership: Supervise 2–3 Assistant Managers/Associates, ensuring high-quality documentation and timely delivery. ● Special Investigations: Lead / perform ad-hoc investigations or fraud risk assessments as required. ● Execution: Conduct end-to-end audits of various functions (Operations, HR, Finance, or Tech) under the guidance of the Manager. ● Fieldwork: Perform walkthroughs, test of effectiveness ($ToE$), and document audit findings with clear "Cause and Effect" analysis. ● Cross-Functional Collaboration: Partner with cross-functional teams to gain deep insights into critical business processes, identify risks, and evaluate the adequacy of internal controls. ● Reporting: Prepare and present clear, concise audit reports to senior management and stakeh

Who we are About Stripe Stripe is a financial infrastructure platform for businesses. Millions of companies—from the world’s largest enterprises to the most ambitious startups—use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Our mission is to increase the GDP of the internet, and we have a staggering amount of work ahead. That means you have an unprecedented opportunity to put the global economy within everyone’s reach while doing the most important work of your career. About the team We are looking for someone passionate about fighting fraud, is naturally curious, and has a strong desire to network with peers and partners within the fraud space. You will be responsible for conducting account investigations, making account-level judgements, and providing support for special handling risk cases. You will be confident in looking through data, assessing various indicators, and making judgements on your findings. The right candidate for this role will ideally have some experience in fraud, preferably within ecommerce or payments, and possess a basic understanding of fraud prevention and controls. What you’ll do Responsibilities Investigate accounts to identify fraudulent merchants, card testing, account takeover, and other fraud vectors Conduct investigations on merchant accounts to support financial partner requirements Assess risk factors and trends of potentially fraudulent activity Help maintain fraud detection strategies and business rules that balance fraud loss and customer experience Contribute to root cause analysis to identify opportunities to predict, prevent, and mitigate risk within process and performance Participate in monthly, quarterly, and annual business reviews for the Fraud Operations team Who you are We’re looking for someone who meets the minimum requirements to be considered for the role. If you meet these requirements, you are encouraged to apply. The preferred qualifications are a bonus,

Who we are About Stripe Stripe is a financial infrastructure platform for businesses. Millions of companies—from the world’s largest enterprises to the most ambitious startups—use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Our mission is to increase the GDP of the internet, and we have a staggering amount of work ahead. That means you have an unprecedented opportunity to put the global economy within everyone’s reach while doing the most important work of your career. About the team We are looking for someone passionate about fighting fraud, is naturally curious, and has a strong desire to network with peers and partners within the fraud space. You will be responsible for conducting account investigations, making account-level judgements, and providing support for special handling risk cases. You will be confident in looking through data, assessing various indicators, and making judgements on your findings. The right candidate for this role will ideally have some experience in fraud, preferably within ecommerce or payments, and possess a basic understanding of fraud prevention and controls. What you’ll do Responsibilities Investigate accounts to identify fraudulent merchants, card testing, account takeover, and other fraud vectors Conduct investigations on merchant accounts to support financial partner requirements Assess risk factors and trends of potentially fraudulent activity Help maintain fraud detection strategies and business rules that balance fraud loss and customer experience Contribute to root cause analysis to identify opportunities to predict, prevent, and mitigate risk within process and performance Participate in monthly, quarterly, and annual business reviews for the Fraud Operations team Who you are We’re looking for someone who meets the minimum requirements to be considered for the role. If you meet these requirements, you are encouraged to apply. The preferred qualifications are a bonus,

Experienced Electrical & Test Engineer Company: The Boeing Company Boeing Defense, Space & Security (BDS) seeks an Experienced Electrical and Test Engineer to serve as an Automated Test Equipment Engineer to join our Patriot Advanced Capability-3 (PAC-3) Electrical Engineering Capability Team in Huntsville, AL . We design, sustain, and upgrade next generation electronics concepts and support production and special test equipment design for increasing capacity requirements. Position Responsibilities: Support design of automated test equipment, development of engineering documentation, and hardware fabrication, integration, and validation testing Develop, document, and maintain electronic and electrical system requirements according to customer desires and contract requirements Create and implement overall Test Equipment Design strategies Review and apply real-time test anomaly troubleshooting and resolution of issues encountered during hardware validation and verification testing Support fielded test equipment hardware and software over the entire product lifecycle Research emerging technologies for potential applications to meet projected requirements Perform Root Cause Corrective Action (RCCA) investigations, troubleshooting, and resolutions This position requires the ability to get a U.S. Security Clearance for which the U.S. Government requires U.S. Citizenship. An interim U.S. secret clearance Pre Start and final U.S. secret clearance Post Start is required. Basic Qualifications (Required Skills/Experience): Bachelor of Science degree in Engineering (with a focus in Electrical, Mechanical or Aeronautical), Computer Sc

At Lyft, our purpose is to serve and connect. We aim to achieve this by cultivating a work environment where all team members belong and have the opportunity to thrive. Lyft is looking for a Litigation Paralegal to join our Legal team. Working closely with Lyft’s in-house litigation team, you will be responsible for conducting investigations, working with cross-functional partners, and helping keep Lyft’s legal operations efficient and organized. You should be a self-starter with a positive attitude who takes ownership of projects and works collaboratively with others. Responsibilities: Assist in-house counsel with administrative tasks, pre-litigation and litigation matters, and responding to legal requests Conduct fact investigations related to pre-litigation matters and filed lawsuits, and assist with corresponding document collection Prepare memoranda and summaries of factual research and make recommendations to supervising attorneys Work cross-functionally with partners outside of Legal to gather facts and information and improve processes Liaise with internal and external counsel on a day-to-day basis Organize and maintain a variety of legal files and information Additional responsibilities may include responding to consumer complaints, managing small claims court cases, and handling diverse special projects for in-house attorneys Experience: Bachelor’s degree and 3+ years relevant legal experience -- administrative, legal, operations, project management A JD or Paralegal certificate is not required for this position Strong oral and written communication skills Collaborative, with ability to cultivate cross-functional relationships Exceptionally organized, efficient, detail-oriented, and articulate Ability to receive general direction and run projects independently Ability to operate in a fast-paced, high volume environment Ability to prioritize competing demands and deadlines Generally comfortable utilizing new technology Proficiency working

At Lyft, our purpose is to serve and connect. We aim to achieve this by cultivating a work environment where all team members belong and have the opportunity to thrive. Lyft is looking to add a Claims Operations Specialists to its growing Risk Team. The Operations Specialist position is an integral role assisting with the processing of claims and responding to inquiries to expedite the handling of claims. The focus of these roles will be cross-functional collaboration and enhanced customer communication focused on the best claims experience for our users. You’ll balance day-to-day responsibilities between independent claims processing and working with our cross-functional teams with a focus on customer obsession and operational excellence. Responsibilities: Create initial loss reports and assist with overall processes for Lyft Healthcare, as well as Lyft Bikes and Scooters Respond and assist with customer inquiries relating to claims Requests additional information, where necessary, for completion of claim processing Manages and coordinates next steps for Accidents; including missing claim searches, adjuster contacts, and enhanced customer experience Coordinate with cross functional teams regarding claims processes, system updates, and customer experience Gathers investigative material and general support to assist adjusters and internal claims teams Develops and delivers effective written and oral communications/reports to management Supports various Risk, Safety, Bikes & Scooters, Express Drive, Legal, Lyft Rentals, and Finance Teams regarding all aspects of insurance claims Supports and facilitates a team environment of continuous feedback and idea sharing with all team members and stakeholders Assist with special projects, including and not limited to auditing and data reconciliation Seeks out opportunities to gain broader insurance knowledge and cross-training Experience: 2+ years experience handling and solving customer support issues - ideally in a

Job Description (JD) for MEP Engineer - Mechanical Lead Projects & Site Integration. Position Summary The incumbent will be responsible for leading engineering design project execution qualification validation commissioning and GMP compliance activities for pharmaceutical manufacturing facilities sterile processing areas NPSB facilities warehouses utilities and associated infrastructure. The role requires end-to-end responsibility from project initiation through facility handover while ensuring compliance with cGMP GEP WHO USFDA EU GMP and ISPE guidelines. Address: D-3/CL, MIDC Industrial Area,Turbhe, Navi Mumbai. 400705 Facility: ZOETIS PHARMACEUTICAL - NAVI MUMBAI Qualification: Post graduate Experience: 10 - 15 years Source: Sodexo India | Job Code: IJP575826

About the Team The Industrial Security team enables OpenAI’s classified and national security work by building secure, compliant programs that support government customers and protect sensitive information. We partner across Security, Legal, People, Facilities, Engineering, IT, and program leadership to translate complex government requirements into practical operating models that allow important work to move forward responsibly. Our work spans personnel security, classified facilities, special programs, government customer engagement, and the safeguards required to operate in highly regulated environments. About the Role As a Senior Special Programs Security Manager, you will lead security operations for OpenAI’s Sensitive Compartmented Information (SCI) and Special Access Programs (SAP), serving in customer-designated roles such as Contractor Special Security Officer (CSSO) or Contractor Program Security Officer (CPSO). You will help shape how OpenAI operates across the Intelligence Community and other national security environments, building the relationships, processes, and security foundations required to support classified work at scale. We’re looking for someone who brings deep special programs expertise, sound operational judgment, and the credibility to work directly with government customers and senior internal stakeholders. This is a hands-on leadership role for someone comfortable navigating ambiguity, helping build the function, mentoring future team members, and finding compliant paths forward when mission needs and security requirements intersect. This role is based in San Francisco, CA, or Washington, DC. We use a hybrid work model of three days in the office per week and offer relocation assistance to new employees. Additional onsite presence and occasional travel may be required based on classified program, facility, and government customer needs. This position requires active Top Secret eligibility, current SCI access, and a current counterintelli

To provide strategic leadership for high-impact transformational initiatives that accelerate Copper Business growth, profitability, operational excellence, sustainability, circular economy, digital transformation, and enterprise value creation. The role converts leadership vision into actionable strategies, identifies growth opportunities, secures cross-functional buy-in, develops investment-linked business cases where required, governs program execution, and ensures implementation at site with measurable business impact. Source: Adani Group | Job ID: 55107