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Fraud Analyst – Fixed Term Contract
The Cigna Group. Manage the team mailbox and respond to or direct enquiries appropriately .
About the role
Key responsibilities & impact- Manage the team mailbox and respond to or direct enquiries appropriately
- Act as the initial review point for possible fraudulent claims
- Identify claims with potential waste and abuse
- Conduct initial review and research to determine whether claims require further investigation for possible fraudulent activity
- Contact providers to request documents and confirm 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 the Data Analytics team to build future FWA trigger automation
- Support production of investigation reports for internal and external stakeholders by compiling and storing evidence appropriately
Requirements
What you’ll need- Minimum of 2 years of health insurance or health care provider experience, with strong preference for experience in fraud investigation
- 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
Benefits
Comp & perks- Competitive salary
- Private Medical Insurance
- Multicultural and hybrid working environment
- Opportunity to work with global teams and contribute to healthcare affordability initiatives