Description
Cigna Healthcare is seeking a Fraud Analyst (Pre-Pay) to join the Payment Integrity Department. As a Fraud Analyst, you will play a crucial role in identifying and preventing fraudulent, wasteful, and abusive expenses globally. You will support the Payment Integrity FWA Team with client reporting and contribute to healthcare affordability initiatives.
Responsibilities:
- Manage the team mailbox and respond or direct enquiries appropriately.
- Act as the initial review point for possible fraudulent claims.
- Identify claims with potential waste and abuse.
- Provide initial review and research to determine if claims require further investigation.
- Contact providers to request documents and confirm information.
- Uphold documentation and process standards.
- Partner with cost containment teams to share best practices.
- Participate in projects to improve business processes.
- Ensure team savings are tracked and reported accurately.
- Collaborate with Payment Integrity teams to share FWA claiming schemes.
- Work with the Data Analytics team to build future FWA triggers automation.
- Support the production of investigation reports for internal and external stakeholders.
Requirements:
- Minimum of 2 years of experience in a health insurance fraud or payment integrity environment, with a strong preference for fraud investigation experience.
- Knowledge of claims coding, regulatory rules, and medical policy.
- Medical or paramedical qualification is a definite plus.
- Demonstrated strong organization skills.
- Strong attention to detail.
- Ability to quickly learn new and complex tasks and concepts.
- Critical mindset with the ability to identify cost containment opportunities.
- Excellent verbal and written communication skills.
- Ability to balance multiple priorities and deliver on tight timelines.
- Flexibility to work with global teams and varying time zones effectively.
- Confidence to deal with internal stakeholders and work with cross-functional teams.
- Fluency in foreign languages in addition to fluent English is a strong plus.
Benefits:
- Competitive salary and Private Medical Insurance.
- Multicultural and hybrid working environment.
- Opportunity to work with global teams and contribute to healthcare affordability initiatives.