Top 117 Senior case Jobs in Rhode Island

Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Rhode Island
- $46,988 - $122,400 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Research
- Health insurance
- Dental insurance
Senior Family Law Attorney (5+ Years Experience) | Lead Turco Legal's Expansion into Rhode Island
Turco Legal, PC —Providence, RI
- $125,000 - $225,000 a year
- Full-time
- Hybrid work
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
5d
Associate Attorney - Criminal Defense (Rhode Island)
Marin & Murphy Law Firm —East Greenwich, RI
- $115,000 - $135,000 a year
- Full-time
- Mid-level
- In-person
- 2 years
- Relocation assistance
- Health insurance
Quick Apply
Personal Injury Attorney
Friar Violet Consulting —Providence, RI
- From $100,000 a year
- Weekends as needed
- Hybrid work
- Spanish
- Writing skills
- English
- Health insurance
- 401(k)
Quick Apply
Channel Marketing Manager
Goods iQ —North Kingstown, RI
- $60,000 - $75,000 a year
- Full-time
- Hybrid work
- Military
- Merchandising
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
RI CNA NEEDED FOR OVERNIGHTS IN WARREN RI 12HR. SHIFTS $25/HR
One Solution Home Care —Warren, RI
- $25 an hour
- 12 hour shift
- Background check
- 18 years or older
- CPR Certification
Quick Apply
5d
Associate General Counsel - Labor & Employment
Care New England Health System —Pawtucket, RI
- $145,690 - $247,064 a year
- Full-time
- Senior level
- Editing
Clinical Research Asst II
Care New England Health System —Providence, RI
- $21 - $33 an hour
- Weekends as needed
- Inventory management
- Computer literacy
- Office
Estate Planning Attorneys
Gordon Rees Scully Mansukhani, LLP —Providence, RI
- $100,000 - $275,000 a year
- Urgently hiring
- Writing skills
- Research
- Mid-level
Managing Senior Counsel - Board of Pharmacy Enforcement
CVS Health —Woonsocket, RI
- $175,100 - $334,750 a year
- Full-time
- Writing skills
- 8 years
- Travel
- Health insurance
- Dental insurance
Business Support Senior Analyst, Revenue Cycle
CVS Health —Rhode Island
- $46,988 - $122,400 a year
- Full-time
- Remote
- Microsoft Outlook
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Senior Payroll Specialist
Care New England Health System —Providence, RI
- Full-time
- English
- High school diploma or GED
- Mentoring
Senior Caseworker
TIDES FAMILY SERVICES INC —Pawtucket, RI
- On call
- Spanish
- Mid-level
- Driver's License
Quick Apply
10d
Senior Program Manager (GCC Operate Phase)
Citizens Financial Group —Johnston, RI
- $175,000 - $250,000 a year
- Full-time
- Hybrid work
- Background check
- Office
- Analysis skills
- Health insurance
- Dental insurance
Director of Workforce Development
Rhode Island Indian Council —Providence, RI
- From $60,000 a year
- Weekends as needed
- 5 years
- Master's degree
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
OP Service Rep per diem
Care New England Health System —Providence, RI
- Per diem
- Hospital
- English
- Mid-level
Director – Paid Search, Discovery & Performance
CVS Health —Woonsocket, RI
- $100,000 - $231,540 a year
- Full-time
- Hybrid work
- Office
- Analysis skills
- Bachelor's degree
- Health insurance
- Dental insurance
Vice President, Total Rewards
Care New England Health System —Providence, RI
- Full-time
- HIPAA
- Employment & labor law
- Master's degree
Guidance Counselor Long Term Substitute - East Greenwich High School
East Greenwich Schools —East Greenwich, RI
- Part-time
- High school
- Mid-level
- Public school
Senior Provider Reimbursement Analyst
Neighborhood Health Plan of Rhode Island —Smithfield, RI
- Full-time
- 5 years
- Finance
- Driver's License
- Health insurance
Quick Apply

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Senior Investigator, Special Investigations Unit (Aetna SIU)

CVS Health -
Rhode Island

Apply Now

Job Details

Full-time
$46,988 - $122,400 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Healthcare financial misconduct investigations
Customer communication
Claim investigation
Microsoft Excel
Microsoft Outlook
Process audits
ICD coding
Research
HCPCS
Documentation tools
Healthcare billing investigations
Legal evidence
Insurance investigations
Healthcare ethical conduct investigations

Full 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.

The SIU Senior Investigator conducts complex investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices.

What you will do

Routinely handles complex cases involving behavioral health or multi-disciplinary provider groups in a prepayment environment
Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc.
Researches and prepares cases for clinical and legal review.
Documents all appropriate case activity in case tracking system.
Prepares and presents referrals, both internal and external, in the required timeframe.
Facilitates the recovery of company lost as a result of fraud matters.
Assists team in identifying resources and best course of action on investigations.
Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters.
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 healthcare fraud matters and Aetna's approach to fighting fraud.
Provides input regarding controls for monitoring fraud related issues within the business units.
Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse

Required Qualifications

3 years working on health care fraud, waste, and abuse investigatory and audits required.
Knowledge of CPT/HCPCS/ICD coding
Knowledge and understanding of clinical issues.
Experience and proficiency in Microsoft Word, Excel, and Outlook, Database search tools, and use in the Intranet/Internet to research information.
Ability to effectively interact with different groups of people at different levels in any situation.
Ability to utilize company systems to obtain relevant electronic documentation.
Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.

Preferred Qualifications

Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI), or have a minimum of three years Medicaid Fraud, Waste and Abuse investigatory experience.
Billing and Coding certifications such as CPC (AAPC)and/or CCS (AHIMA)
Knowledge of Behavioral Health policies and procedures.
Experience working Behavioral Health fraud cases.
Strong analytical and research skills using health care data.
Strong communication and customer service skills.
Proficient in researching information and identifying information resources.

Education

Bachelor's degree, or an Associate's degree, with an additional three years (3 years total) working on health care fraud, waste, and abuse investigations and audits required.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $122,400.00

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: 07/29/2026

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

Apply Now

Refine Your Search

senior case jobs in rhode island

Senior Investigator, Special Investigations Unit (Aetna SIU)

Senior Family Law Attorney (5+ Years Experience) | Lead Turco Legal's Expansion into Rhode Island

Associate Attorney - Criminal Defense (Rhode Island)

Personal Injury Attorney

Channel Marketing Manager

RI CNA NEEDED FOR OVERNIGHTS IN WARREN RI 12HR. SHIFTS $25/HR

Associate General Counsel - Labor & Employment

Clinical Research Asst II

Estate Planning Attorneys

Managing Senior Counsel - Board of Pharmacy Enforcement

Business Support Senior Analyst, Revenue Cycle

Senior Payroll Specialist

Senior Caseworker

Senior Program Manager (GCC Operate Phase)

Director of Workforce Development

OP Service Rep per diem

Director – Paid Search, Discovery & Performance

Vice President, Total Rewards

Guidance Counselor Long Term Substitute - East Greenwich High School

Senior Provider Reimbursement Analyst

I want to receive the latest job alert for senior case in rhode island

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