Senior Fraud Risk Management Expert in United States

We believe that the way people interact with their finances will drastically improve in the next few years. We’re dedicated to empowering this transformation by building the tools and experiences that thousands of developers use to create their own products. Plaid powers the tools millions of people rely on to live a healthier financial life. We work with thousands of companies like Venmo, SoFi, several of the Fortune 500, and many of the largest banks to make it easy for people to connect their financial accounts to the apps and services they want to use. Plaid’s network covers 12,000 financial institutions across the US, Canada, UK and Europe. Founded in 2013, the company is headquartered in San Francisco with offices in New York, Washington D.C., London and Amsterdam. We are the first line of defense against fraud and abuse on the Plaid platform. Our mission is to ensure the safety and integrity of our platform for consumers and customers. As a Fraud and Abuse Operations Analyst , you will be responsible for responding to fraud and abuse events, investigating claims, and triaging incidents. We also partner with product and engineering teams to inform and improve fraud mitigation strategies. Responsibilities: Safeguard Plaid's Platform: Participate in the abuse on-call rotation, directly protecting our users and customers by responding to and resolving fraud and abuse events. Your timely actions will be instrumental in maintaining trust and security. Drive Investigations and Mitigate Risks: Investigate fraud and abuse claims from diverse sources, partnering with senior teammates on complex cases. Your findings will inform decisions and strategies, directly impacting Plaid's ability to prevent future incidents and minimize financial losses. Proactively perform threat modeling of abuse surfaces and continuously survey external fraud trends, adversary techniques, tooling, and emerging threat vectors Support Incident Response: Help triage and manage fraud and abuse ev

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

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 Waste & Error Certified Coding Manager is responsible for leading the Certified Coding Analyst and W&E Team Lead roles that conduct medical claim reviews and coding audits to identify billing errors, waste, abuse, fraud, and payment integrity opportunities. The Manager provides direct people leadership, establishes operational priorities, ensures consistent application of coding and billing requirements, and is accountable for team productivity, quality, service levels, compliance, and employee development. This role partners closely with the W&E team lead, who provides day-to-day technical guidance and subject matter support to the coding team. The Manager retains accountability for staffing, performance management, workload oversight, escalations, audit readiness, process improvement, and delivery of business outcomes. The position also represents the team in discussions with senior leadership, Medical Directors, Legal, Compliance, Analytics, Operations, and other Payment Integrity partners. Primary Responsibilities People Leadership & Team Development Lead, coach, and develop a team of Certified Coding Analysts and Senior Certified Coding Analysts. Establish clear role expectations, performance goals, productivity standards, quality requirements, and accountability measures. Conduct regular perfor

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 Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj

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 As a Senior Data Insights Specialist, you will be responsible for using SQL, MS Excel, Dataiku, Python, and related applications to determine disruption to existing and potential clients when network changes take place to retain and win business. This position involves making high-level decisions, managing multiple requests/priorities, developing new solutions to simplify the reporting process, and producing both standard and custom reports for multiple lines of business and specific clients regarding retail pharmacy network accessibility. Required Qualifications Experience in SQL, Microsoft Excel, and other relevant applications. Experience with data cleaning, transformation, and/or ETL. Strong analytical and problem-solving skills with the ability to interpret complex data sets. Preferred Qualifications 2&#43; years' of professional analytical experience. Proficiency in Dataiku, Alteryx, or other related ETL applications. Experience with Python. Experience with Salesforce. Working experience in the Pharmacy Benefits Management (PBM) or related healthcare industry. Excellent verbal and written communication skills to effectively interact with internal teams and external clients. Ability to manage multiple requests and priorities in a fast-paced environment.</li

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 We are hiring a Senior Full Stack Software Development Engineer with strong React and Python (with .NET as a nice-to-have) experience to join our Data Engineering team. You will serve as a key senior contributor, driving the end-to-end development of a new, critical internal self-service application. Your work on this software solution will be instrumental in our initiative to modernize how data is accessed and managed, enabling teams across the company to more easily work with their own data through the user-friendly tools you build. This project involves a shift from traditional data handling processes, with your primary focus being on creating a robust application that empowers this new approach to data accessibility and decentralized ownership. About this Role: This is a high-impact, high-autonomy role suited for a detail-oriented and collaborative individual who thrives on ownership, knows how to apply best practices, and can independently design, build, and maintain production-grade software. While you'll be leveraging your core software engineering expertise, you'll also be at the forefront of our data modernization, gaining deep insights into modern data architectures and practices by building the tools that enable them. You will have access to AI tooling to assist in all aspects of the SDLC. Y

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 We are hiring a Senior Product Manager to help lead our Caremark advocacy portfolio, a new, high-priority initiative that sits within an established, well-resourced team. This role will drive the continued development and expansion of Pharmacy Navigator, which is currently in its pilot phase. Pharmacy Navigator offers proactive outreach to Caremark PBM members at potential friction points in their healthcare journey. The role will work on a variety of high-visibility priorities, including feature development, developing client and internal reporting, and expansion of the product into new markets. What you will do: Analyze customer and member needs, pain points, and preferences to guide product development and ensure customer-and-member-centric solutions. Partner with Caremark operations, clinical, and technology teams to define the product vision, set strategic goals, evaluate opportunities, assess member and business impact, and develop business cases and recommendations for scaling the product. Identify opportunities to expand Pharmacy Navigator, including new member pain points, therapeutic areas, formulary and prior authorization transitions, and new lines of business. Identify existing technologies across the organization and determine how they can be leveraged in new product builds. Lead discovery and solutioning effor

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 Senior Data Engineer will be responsible for delivering high quality modern data solutions through collaboration with our engineering, analysts, data scientist, and product teams in a fast-paced, agile environment leveraging cutting-edge technology to reimagine how Healthcare is provided. You will be instrumental in designing, integrating, and implementing solutions on-premise as well supporting migrations of existing workloads to the cloud. The Senior Data Engineer is expected to have extensive knowledge of modern programming languages, designing and developing data solutions. The position is open in a data engineering team that is responsible for processing payer files into our Data Warehouse. Required Qualifications 6&#43; years of experience working with SQL and relational database management systems 3&#43; years of experience in Cloud Data Engineering Platforms such as AWS, GCP, Azure, Databricks, Snowflake etc. 3&#43; years of experience in on-prem Data Engineering Platforms such as Microsoft SQL Server, Oracle, Teradata etc. Programming and modifying code in languages like SQL, Python, and PySpark to support and implement Cloud based and on-prem data warehousing services.</spa

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 Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities. This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience. Responsibilities Include: Strategic Leadership Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives. Establishes operational strategies, and performance standards that support long-term scalability and sustainability. Leads implementation of new NCOD workflo

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 As a Digital Analytics Senior Analyst, you will work closely with product teams to evolve and improve our digital experiences for customers and patients. You will use your analytical and problem-solving skills to define success metrics and measurement approaches to ensure our digital experiences stay healthy. You will collaborate with other motivated teammates across UX, Customer Experience Management, IT, Site Optimization, Marketing and Merchandising. Required Qualifications 1&#43; years of relevant experience for those in a CVSH leadership program (such as DAP, Leadership development, GMDP, etc.) OR 2&#43; years of relevant experience for others Preferred Qualifications Knowledge of online analytics tools such as Adobe, Coremetrics, Localytics, Webtrends, etc Experience in Tableau/Power BI, SQL (Teradata, Hadoop, Google Cloud Platform, etc.) Experience with highly quantitative analytics Project oriented, pro-active, and self-motivated work style with proven ability to manage effectively multiple projects and changing priorities in an extremely fast paced environment and constantly deliver superior results within given deadlines Strengths in structured and logical thinking, problem solving, issue resolution, and attention to detail Education - Bachelor’

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 A Workday Integration Senior Developer is a specialized technical role responsible for designing, developing, implementing, and maintaining integrations between Workday and other internal or external systems. This role requires deep technical expertise in Workday’s integration tools, integration methodologies, Workday Extend and best practices to ensure data flows smoothly and accurately between Workday and other enterprise and external system. Responsibilities include: Design Integration Solutions: Lead the design and development of integration solutions between Workday and external systems (such as payroll, benefits, HR, finance, or third-party applications). Writes code, develops software components, and implements complex functionalities according to project requirements. Workday Studio: Use Workday Studio to develop complex integrations involving multiple systems, including configuring web services (REST/SOAP), developing transformation logic, and handling data mappings. Workday Extend: Development and Configuration of Workday Extend Apps and Workday Orchestration. Pre-built Connectors: Leverage Workday Cloud Connect and other pre-built connectors to integrate Workday with third-party applications efficiently. Customization: Customize integrations to meet the unique busine

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 Collaborate with other Design, Product, and Development managers to ensure alignment across projects Collaborate with Design and cross functional teams to ensure Design team quality, efficiency and velocity meets team needs Develop deep understanding of customer journeys, personas and segmentation within your portfolio of projects Translate complex cognitive challenges across multiple projects into elegant user experiences delivered across multiple channels Gain stakeholder support for designs by clearly communicating design vision and rationale Conceptualize, design and define breakthrough user experiences, drawing inspiration from research, user goals, and the world around you Required Qualifications 7&#43; years of professional work experience Has a minimum of 5 years’ experience in Desktop, native app design, including XD and visual design Has proven experience in driving and delivering design from initial concepts to in-market experiences Has 3 ye

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 Senior Actuary - Network position within the network analytics team provides the financial tools and analytics to support network strategy in alignment with market/business growth priorities. The market-specific responsibilities will provide individuals with the opportunity to develop in-depth knowledge of market dynamics and to establish strong cross-functional relationships with key business partners, including network, MEU, and commercial actuarial teams. Additional core areas of focus include network discounts, emerging trend analytics, and pricing and contracting support. Key responsibilities will include: Discounts – Develop a quarterly, market-level discount review process to inform Regional Leads and Chief Network Officers of changes in benchmarking based on the latest view, identifying gaps and pressured areas to consider for future negotiations. Provide meaningful information to the field on the impact and expected timing of new negotiations beyond current consultant benchmarking. Emerging Trend Analytics – Engage cross-functionally with Network, MEU, and other teams to drive enhanced contract negotiation strategies using data-driven recommendations for MedRx and Behavioral Health. Pricing – provide support for Aetna Whole Health / APCN Plus (Performance Networks), joint ventures, and narrow network pricing across all

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 Workforce Optimization Manager plays a critical role in shaping and executing workforce strategies. This position leads the end-to-end lifecycle of workforce optimization initiatives. Acting as a trusted advisor, this role partners with leaders across all levels to align workforce plans with business objectives, proactively anticipate organizational needs, and mitigate risk through compliance with employment laws and sound governance. This role has no direct reports but manages an important process within the workforce optimization space. Key Responsibilities Drive end‑to‑end project management for high‑impact workforce optimization initiatives, operating effectively in grey areas where requirements, risks, and stakeholder inputs may be evolving. Partner closely with Government Affairs, Legal, Talent Acquisition, Communications, and HR to scope work, align resources, manage timelines, mitigate risk while managing the project plan. Serve as an enterprise‑wide strategic advisor to leaders at all levels, providing consultative guidance in complex, ambiguous, and high‑impact scenarios where solutions are not clearly defined and require strategic judgment, influence, and risk assessment to inform workforce strategy and future‑state design. Influence talent decisions by evaluating current capabilities against future organizational needs, iden

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. Senior Manager, Platform Engineering / DevOps Who Are You You are an experienced Senior Manager / emerging Staff-level leader in DevOps and Platform Engineering with strong technical depth and demonstrated leadership in delivering enterprise-scale cloud platforms. You bring a balanced mix of hands-on engineering expertise, team leadership, and execution rigor. You excel in driving outcomes in complex, multi-stakeholder environments, guiding teams to deliver secure, scalable, and high-quality platform solutions. You are comfortable leading engineers, managing stakeholders, and owning delivery across multiple workstreams. You demonstrate: A strong ownership mindset with accountability for delivery and outcomes Ability to translate business needs into actionable engineering roadmaps Solid expertise in cloud-native platforms, DevOps practices, and SRE principles Capability to lead teams and influence without requiring extensive tenure Role Responsibilities Development & Enforcement Own and execute the H100 platform engineering roadmap, aligned to enterprise priorities and program milestones Drive delivery of GCP-based platform capabilities (GKE, networking, IAM, CI/CD, observability) Establish and enforce engineering standards, best practices, and ADR compliance <li