Detalles de la oferta

.Fraud Analyst The job profile for this position is Fraud Analyst, which is a Band 2 Senior Contributor Career Track Role.Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success.Role Summary:As Fraud Analyst within Payment Integrity Team you will be directly supporting Cigna's affordability commitment within Cigna International's business. This role is responsible for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring within a dedicated region (Americas geography, dedicated to the GIH Book of Business). He/She will work closely with other PI team members, Network, Data & Analytics, Claims Operations, Clinical partners, Product and Member Investigation Unit (MIU).Responsibilities:Investigate potential instances of fraud, waste or abuse (FWA) across Cigna's International Markets books of business for claims incurred in a dedicated region.Ensure PI savings are tracked and reported accurately.Negotiation with providers contracted by Cigna or out-of-Network providers. Review existing cases for any FWA trends and patternsPartner with Cigna TPAs on provider investigations.Partner with Payment Integrity teams in other locations to share FWA claiming schemes.Partner with Data Analytics team in building future FWA triggers automation.Review FWA tools to support in identification of cases along side senior investigators Adhere to turn around times and timelines on investigationsContact providers and members requesting documents and confirming information. Work with team members and manager to develop FWA cases Skills and Requirements:Working knowledge of GIH claims processes and systemsYou should enjoy working in a team of high performers, who hold each other accountable to perform to their very best.Experience of fraud investigation strongly desired. Minimum of 2 years of health insurance or health care provider experience. Knowledge of claims coding, regulatory rules and medical policy.Medical/ paramedical qualification is a definite plus.Critical mind-set with ability to identify cost containment opportunities.Experience with data analytics tool(s) is a strong asset.Excellent verbal and written communication, interpersonal and negotiation skills.Ability to balance multiple priorities at once and deliver on tight timelines.Flexibility to work with global teams and varying time zones effectively.Confidence to deal with internal stakeholders and ability to work with a cross functional team.Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines.Fluency in foreign languages in addition to fluent English is a strong plus


Salario Nominal: A convenir

Fuente: Jobtome_Ppc

Requisitos

Analista Programador Cobol Host Madrid · Completamente Remoto

Hola a Tod@s, estamos buscando un perfil Analista Programador Cobol Host.Experiencia en Cobol, JCL, CICS, DB2. Valorables experiencia en Partenon y medio de ...


Tecdata Engineering - Madrid

Publicado 13 days ago

Analyst | Madrid (2024-25 Start)

We are one of the world's leading economic consulting firms. We strive to recruit and develop talented people to work together to produce meaningful economic...


Compass Lexecon - Madrid

Publicado 13 days ago

Operations Analyst- Seguridad Industrial

¿Tienes experiencia en Seguridad Industrial? ¿Has trabajado anteriormente en HSSE en un entorno Industrial/Químico/a? ¿Te gusta viajar? ¿Tu nivel de inglés e...


Adecco (Spain) - Madrid

Publicado 13 days ago

Senior Data Analyst

We're looking for a dynamic and results-oriented Senior Sales Analyst to join our growing Data team. If you have a passion for data, enjoy working cross-func...


Make - Madrid

Publicado 13 days ago

Built at: 2024-12-26T17:44:59.935Z