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