.Job Title: Fraud Analyst Role Summary: As a Fraud Analyst within the 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).
You will work closely with other PI team members, Network, Data & Analytics, Claims Operations, Clinical partners, Product, and the 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.
Negotiate with providers contracted by Cigna or out-of-Network providers.
Review existing cases for any FWA trends and patterns.
Partner with Cigna TPAs on provider investigations.
Collaborate with Payment Integrity teams in other locations to share FWA claiming schemes.
Work with the Data Analytics team in building future FWA triggers automation.
Review FWA tools to support in the identification of cases alongside senior investigators.
Adhere to turnaround times and timelines on investigations.
Contact 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 systems.
Enjoy working in a team of high performers who hold each other accountable to perform their very best.
Experience in fraud investigation is 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 mindset with the 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 organizational 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.
Hybrid work location About Cigna Healthcare: Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life.
We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality.
Join us in driving growth and improving lives