# Quality Review and Audit Prepay Supervisor

**Company**: Cigna
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cigna.wd5.myworkdayjobs.com/en-US/cignacareers/job/Kuala-Lumpur-Malaysia/Payment-Integrity-Prepay-Fraud-Supervisor---Cigna-Healthcare_26011273-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_f81e8b86-b7f

## Description

As a Quality Review & Audit Supervisor within the Payment Integrity Pre-Payment Team at Cigna International, you will lead a remote, regionally focused prepayment team to identify and prevent fraudulent, wasteful, and abusive expenses within Cigna's International Business Market.

Responsibilities:

- Lead the Regional Prepayment team to identify claims that should not be paid and potential Fraud, Waste, and Abuse savings

- Work closely with Payment Integrity management to execute departmental plans and priorities

- Manage internal stakeholder relationships

- Coach and support team members to monitor and identify non-compliance in billing and claims payment activity

- Ensure department KPIs are met through effective monitoring and reporting mechanisms

- Execute strategic initiatives, plans, and goals in alignment with department KPIs and financial targets

- Ensure payment integrity processes comply with legal, regulatory, and contractual requirements

- Assess work demand against capacity to ensure optimum claim referrals

- Instil a work culture of continuous process improvement, innovation, and quality

- Oversee departmental personnel matters, including performance appraisals and adherence to company practices

- Assist in organising on-boarding and training of new hires

- Perform verification of services and charges, and negotiate with providers

- Recommend changes in policy and procedures to mitigate risk

- Provide input into workforce planning and recruitment activities

- Provide feedback to other departments to prevent further risk exposure

- Work closely with other departments to ensure Payment Integrity activities do not negatively impact customers

Skills and Requirements:

- Demonstrated strong organisation skills

- Strong attention to detail

- Ability to quickly learn new and complex tasks

- Competent in processing or investigating claims on GlobalCare and/or Actisure claim platforms

- Minimum 2 years of health insurance or international health care provider experience

- Minimum 1 year of experience in a Payment Integrity function preferred

- Fluency in foreign languages in addition to fluent English is a strong plus

- Knowledge of medical terminology and treatment modalities is a plus

- Data analysis and reporting skills preferred

- Inquisitive nature with critical thinking and problem-solving skills

- Comfortable working independently and with a team

- Flexibility to work with global teams and varying time zones

- Ability to balance multiple priorities and deliver on tight timelines

- Proficiency with Microsoft Excel, Word, PowerPoint, Outlook, and SharePoint

## Skills

### Required
- organisation
- attention to detail
- claims processing
- health insurance experience
- Payment Integrity experience

### Nice to have
- foreign language fluency
- medical terminology knowledge
- data analysis and reporting
- Microsoft Excel proficiency

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Source: [Apply at cigna.wd5.myworkdayjobs.com](https://cigna.wd5.myworkdayjobs.com/en-US/cignacareers/job/Kuala-Lumpur-Malaysia/Payment-Integrity-Prepay-Fraud-Supervisor---Cigna-Healthcare_26011273-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)