Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. Independence American Insurance Co is seeking a Carrier Operations Fraud Analyst who will report to the Director, Carrier Operations. The Carrier Operations Fraud Analyst is responsible for managing and overseeing the Special Investigations Unit (SIU) program for IAIC and IPIC, ensuring compliance with state regulations and filed fraud plan. This role leads fraud investigations, coordinates reporting and required audits, and develops processes to detect and prevent fraudulent activity. The analyst collaborates with internal teams, administrators, and state regulators to maintain program integrity, drive continuous improvement, and support operational compliance. Job Location: Remote – USA Main Responsibilities: - Lead fraud investigations of referrals; report referrals to regulatory bodies and assist state investigators with requests. - Manage annual SIU reporting requirements for the IPH carriers; submit reports to state regulatory bodies. - Collaborate with administrators to proactively detect fraud, analyze trends, and escalate emerging concerns. - Oversee SIU program operations, collaborate with Director of Carrier Operations and administrators to evaluate processes, workflows, and key risk indicators (KRIs). - Collaborate with DOI law enforcement on fraud investigations and case development. - Create and maintain monthly fraud reporting for carrier leadership. - Facilitate SIU Committee meetings; prepare agendas, present fraud referrals - Facilitate fraud meetings internally and with administrators; prepare agendas, share trends, schemes, and fraud activity. - Ensure completion of DOI-mandated annual fraud training for all SIU employees; manage distribution, follow-ups, certificate collection, and maintain logs for state submission. - Audit administrators and carrier employees annually to confirm fraud training adherence; work with HR and management to resolve gaps. - Maintain and update carrier fraud training programs to meet state requirements, coordinate scheduling and delivery with HR. - Build and maintain fraud-related workflows and handoffs between carrier and administrators. - Develop and maintain process documentation, procedures, and carrier guidelines; provide to states as needed. - Maintain and update fraud plans and organizational charts for carriers; ensure annual review and filing with states. - Create and manage documentation and logs for referrals and investigations. - Create notices and cancellation letters for policyholders and other required parties. - Conduct administrator audits to validate adherence to fraud processes, filed fraud plan and state requirements. - Collaborate with leadership to identify process improvements and drive efficiencies across fraud detection and reporting. - Provide backup support to other areas in the Carrier Operations department. - Performs other duties and responsibilities as assigned. Basic Qualifications: - Bachelor’s degree in Business, Insurance, Criminal Justice, or related field preferred. - Minimum of 3 years of experience in insurance operations, fraud investigation, or compliance. - Strong understanding of insurance operations, regulatory standards, and compliance requirements. - Claims and claims data analysis experience is a plus. - Experience with state fraud reporting, audits, and fraud investigation. - Familiarity working with state investigators highly desirable. - Experience developing workflows, processes, and training programs preferred. - Strong understanding of operations, insurance fraud detection, SIU requirements, and regulatory compliance. - Excellent investigative and analytical skills with attention to detail. - Strong organizational and project management abilities. - Ability to interpret and apply state regulations related to fraud and SIU programs. - Proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint). - Strong written and verbal communication skills; ability to present complex fraud cases clearly. Expected Hours of Work: - This is a full-time position: Days and hours to be determined by needs of business. Hours to be determined between employee and director #li-Remote All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: - Comprehensive full medical, dental and vision Insurance - Basic Life Insurance at no cost to the employee - Company paid short-term and long-term disability - 12 weeks of 100% paid Parental Leave - Health Savings Account (HSA) - Flexible Spending Accounts (FSA) - Retirement savings plan - Personal Paid Time Off - Paid holidays and company-wide Wellness Day off - Paid time off to volunteer at nonprofit organizations - Pet friendly office environment - Commuter Benefits - Group Pet Insurance - On the job training and skills development - Employee Assistance Program (EAP) Interview Technology Notice: Please note that phone and video interviews or screenings may be recorded and transcribed using interview technology to support our recruitment process. By continuing with the interview, you consent to this use. Text Messaging Notice: If you provide a mobile phone number, you may receive job-related communications via text message. Message and data rates may apply. You may opt out of text communications at any time by replying “STOP.”

• Research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. • Provide thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. • Document decisions within mandated timeframes and in compliance with applicable regulations or standards. • Document the basis of the appeal or retrospective review in an accurate and timely manner and in accordance with applicable regulations or standards. • Perform thorough research of the substance of service appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies, and procedures, while adhering to confidentiality regulations regarding protected health information. • Perform appeal and retrospective reviews demonstrating ability to define and determine precedence of pertinent issues in application of policies and procedures to clinical information and or application to benefit or policy provisions. • Perform special projects including reviews of clinical information to identify quality of care issues.

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. Job Purpose and Summary: Resource Planning Analyst is responsible for the real-time monitoring including current and upcoming week analysis including management of work and resources across multiple queues to maintain appropriate service/inventory level performance. Analysis includes the real-time readjustment of work forecasts (Volume and Rates/AHT) by utilizing Verint (or current/relevant Workflow/WFM tool) mid-day/mid-week and influences/coordinates solutions to parallel operations partners as needed to account for those adjustments. Those solutions would be (but are not limited to): - Utilization of resources from across groups/queues VTO/OT needs Schedule adjustments to optimize service level performance and agent occupancy - Analysis of impact and approval of all scheduling activity within owned queues such as Movement/Utilization of Resources to/from other areas, Agent Schedule Adjustments, Same Day Schedule Adjustments, Training, Team Meetings, etc. - Ensures closed loop communications with peers within Resource Planning (Long Range, Analyst II and Vendor RP) around deviations to metrics that impact the overall resource plan to properly predict capacity requirements. - Works in conjunction with Peers, Leaders, and Vendor Management to implement tactics dependent on the line of business performance or service impacting events. This role is the main communication coordinator for any service impacting event, including internal site and external vendor impacts for their specific area/line of business/queues. They are also responsible for being the central point of contact to handle communication and action plans around any implemented contingency plans. - Ensures the maintenance of colleague skilling profiles within Verint and Avaya CMS Supervisor/Five9, ensuring skilling script accuracy. - Owns planning, coordinating, and scheduling optimal times for unplanned non-production activities including trainings, meetings, etc. - Owns daily morning readout covering the prior day performance, current day/week outlook and following week outlook with Operations and other key stakeholders. Primary Job Duties & Responsibilities: - 65% - Identify and act on appropriate actions to achieve the desired outcomes. Monitor, Analyze and Manage the work within assigned queues real time and within the current week to ensure service level performance and occupancy requirements are achieved. - 20% - Attend all meetings that ensure closed loop communications with peers within Resource Planning (Long Range, Analyst II and Vendor RP) around deviations to metrics that impact the team at larges ability to properly predict capacity and capacity needs for assigned queues/line(s) of business. - 10% - Ensure the accuracy of agent skilling and attribute profiles within Verint, Avaya CMS, 5Nine and the specialty Rx processing system (SPRx). - 5% - Communicate service impacting events and quantify operational impact of any applicable Significant Event Notifications to all Resource Planning teams, operational leaders and Vendor Management for assigned queues/line(s) of business. Required Qualifications: - Minimum 3 years Resource Planning or equivalent Operational experience in multi-site environment. - Minimum 3 years experience in utilizing Avaya CMS Supervisor, Five9 or similar ACD system for contact center management and reporting. - Minimum 3 years experience in utilizing Verint workforce management software or similar application. - Proficiency utilizing Microsoft Excel for data analysis - Ability to learn quickly while understanding and solving new problems Ability to perform root cause investigation, problem solve, articulate conclusions and make recommendations Communicate effectively and confidently utilizing excellent analytical, written, and verbal skills Preferred Qualifications: - Knowledge of healthcare and/or pharmacy benefits management organizations - Specialty Pharmacy Experience - MS Office, Tableau, Power BI - Ability to work extended hours including evenings, weekends, and holidays. Education: - High School Diploma or General Equivalent Development (GED) - Required - Bachelor Degree - Preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $43,888.00 - $102,081.00 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: 05/23/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• Conduct data-driven and literature-based analyses on LMIC healthcare markets, product and disease landscapes, and access barriers • Gather and synthesize evidence from diverse sources, transforming complex information into clear, structured insights • Support quantitative and qualitative analyses on topics such as portfolio strategy, health system readiness, and health financing • Contribute to the design and refinement of research tools, frameworks, and models used in client work • Develop well-structured presentations, reports, and briefing materials that clearly communicate findings • Support the preparation of meeting materials and contribute to client discussions through clear, evidence-based insights • Ensure accuracy, clarity, and consistency in all written and visual deliverables • Maintain organized documentation of research and analytical outputs for internal and client use • Support research on innovative financing mechanisms and their application in LMIC settings • Analyze market and financing data to inform access strategies and support client recommendations • Collaborate closely with Associates, Engagement Managers, and Principals to deliver high-quality outputs on time • Demonstrate ownership for assigned tasks and a proactive approach to problem-solving • Continuously build knowledge of LMIC health systems, access challenges, and market-shaping dynamics • Contribute to internal learning efforts and the development of shared tools and frameworks • Demonstrate openness to feedback and a growth mindset, actively seeking opportunities to learn, improve, and build new skills