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.
Minimum of 2 years in health insurance fraud, payment integrity environment, with a strong preference for fraud investigation experience.
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.
Why Join Us
Competitive salary and Private Medical Insurance.
Multicultural and hybrid working environment.
Opportunity to work with global teams and contribute to healthcare affordability initiatives.
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: SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response.
