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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

The Advisor-Investigations/Compliance provides expert healthcare fraud, waste, and abuse investigative expertise in support of specific Federal Health Benefit Plans (FEHB) and other government related clients. The Advisor-Investigations/Compliance is effective at working collaboratively with internal partners and external parties including CVS Health corporate security, pharmacy audit and network teams, the client’s special investigations unit (SIU), and Federal, State, and local law enforcement agencies.

The Advisor-Investigations/Compliance will utilize their knowledge of the legal system and experience working in medical, pharmaceutical, legal and/or criminal investigations to develop and submit fraud case referrals to the client for potential submission to the Office of the Inspector General (OIG), Office of Personnel Management (OPM), and/or State Attorney Generals.

The Advisor-Investigations/Compliance supports the Quality Prescription Services (QPS) program achieve its goal to ensure appropriate utilization of the client’s pharmacy benefit as well as the client’s satisfaction, while enhancing member safety. This is a client facing role.

What you will do

o The Advisor, Investigations/Compliance Ops provides investigative expertise in support of QPS, a fraud, waste and abuse program for PBM clients with federal and/or state government employees.

o Leads efforts to detect and investigate instances of fraud and abuse within the program.

o Develops and implements proactive measures, such as data analytics, claims reviews, and other investigative techniques, to identify suspicious patterns or practices that may indicate fraudulent activities.

o Assists in the development of investigation plans and strategies to effectively address potential fraud or abuse cases.

o Ensures quality documentation of investigation activities, including evidence collection, witness statements, case files, and other relevant information to facilitate transparency.

o Contributes to the development and enhancement of policies, procedures, and protocols related to QPS investigations.

o Supports the QPS department achieve its goal to ensure appropriate utilization of the federal and/or state government health plan pharmacy benefit

This position is a remote position, and candidates can live anywhere in the US, however it is preferred that candidates live in the Phoenix Valley Metro area and are able to come into the office 1 day per week.

Required Qualifications

o 5 or more years of relevant work experience.

o Investigative work experience.

o Experience managing multiple cases loads.

o Experience training peers and presenting to leadership.

o Experience/ Proficy with the Microsoft office suite.

Preferred Qualifications

o Healthcare fraud investigations experience.

o Pharmacy Benefit Manager (PBM) experience.

Education

o Bachelor's degree required, may consider equivalent experience in lieu of a Bachelor's degree.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .

+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 11/28/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.