• Job Description

  Req#: 23019316
  Role Summary:
  
  As a Fraud Analyst (Pre-Pay), within the Payment Integrity Department you will be directly supporting Cigna's affordability commitment within Cigna International's business. This role is responsible for identifying and preventing fraudulent, wasteful and abusive expenses from around the globe and supporting the Payment Integrity Fraud Waster Abuse (FWA) Team with client reporting.
  
  Responsibilities:
  
  • Manages Team mailbox and responds or directs enquiries appropriately.
  • Acts as initial review point for (possible) fraudulent claims.
  • Identifying claims with potential waste and abuse
  • Provides initial review and research to help determine if claims require further investigation to determine possible fraudulent activity.
  • Contact providers requesting documents and confirming information.
  • Uphold documentation and process standards
  • Partner with cost containment teams in other geographies to share best practices.
  • Participate in projects to improve business processes.
  • Ensure team savings are tracked and reported accurately.
  • Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
  • Partner with Data Analytics team in building future FWA triggers automation.
  • Support the production of investigation reports to internal and external stakeholders by compiling and storing evidence appropriately.
  
  
  Skills and Requirements:
  
  • You 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.
  • Competent in processing or investigating claims on Mainframe.
  • Knowledge of claims coding, regulatory rules and medical policy.
  • Medical/ 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 mind-set with ability to identify cost containment opportunities.
  • Excellent verbal and written communication 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.
  
  
  If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
  
  For this position, we anticipate offering an hourly rate of 23 - 35 USD / hourly, depending on relevant factors, including experience and geographic location.
  
  This role is also anticipated to be eligible to participate in an annual bonus plan.
  
  We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
  
  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.
  
  Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
  
  If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
  
  The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

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