Job Description

Job Description
The Aetna Special Investigations Unit (SIU) is responsible for the detection, investigation, and prevention of all suspected cases of healthcare fraud. The Project Lead position resides within our Systems & Reporting team. The team is accountable for financial reporting, application development, investigative reporting support and analytic techniques to uncover patterns of fraud, waste or abuse within claims data. We are looking for a data-driven individual that can analyze big data and create a story through data aggregation and reporting.

Job responsibilities include:
- Oversee and or assist project team with creating complex queries, complex technical programming
- Knowledge of analytics tools to analyze large data sets to identify trends, spikes or anomalies within the data
- Create and communicate messages based on available data from real-time analyses, including preparing easy-to-understand charts, tables, graphs, and other related documents for diverse audiences
- Understand data nuances; improve data quality
- Work with advisers from key functional areas to understand potential project impact on the organization, align project work, and execute activities accordingly
- Present to internal/external customers, constituents and business partners
- Oversees the analysis, planning, design and development being performed by project team to support accurate maintenance of support systems for business areas.
- Influences change or enhancements to business processes, policies and system infrastructure to improve information quality, availability and access.

Required Qualifications
The ideal candidate would have:
- Solid understanding of medical and pharmaceutical claim data
- Intermediate or Advanced SAS and SQL coding experience
- Advanced experience in Excel
- Demonstrated ability to effectively coordinate multiple projects simultaneously
- Excellent verbal and written communication skills
- 3+ years of data interpretation and analysis experience
- 3+ years of project management experience
- 2+ years of demonstrated leadership

Preferred Qualifications
- Experience as a business developer in Tableau or Power BI to create and maintain internal dashboards, trends and metrics
- MS Access

Education
Bachelor's degree or equivalent work experience.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.