Healthcare Fraud Investigator

The Cigna Group

. Conduct and support investigations and audits involving suspected healthcare fraud and potentially fraudulent claim activity .

Posted 10/27/2026full-timeRemote • United StatesMid-LevelSenior💰 $68,300 - $113,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare fraud investigations and auditing, with strong analytical skills to evaluate claims and document findings. Proficient in preparing investigative reports and collaborating with law enforcement and insurance agencies.

Highest-signal resume keywords

Healthcare Fraud InvestigationsClaims AuditingAnalytical SkillsExcellent Communication SkillsAHFI Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative AnalysisFraud DetectionDocumentation PreparationEvidence Package DevelopmentOn-Site InspectionsPatient InterviewsProvider InvestigationsClaims AnalysisReport WritingSubpoena Response

Soft Skills

Strong CommunicationDetail-OrientedCritical ThinkingProblem SolvingTeam Collaboration

Tools & Technologies

Microsoft ExcelMicrosoft AccessMicrosoft Word

Certifications & Qualifications

Accredited Health Care Fraud Investigator (AHFI)Certified Fraud Examiner (CFE)

Industry Keywords

Healthcare ClaimsSpecial Investigations Units (SIU)Fraudulent Claim ActivityInsurance FraudJudicial Proceedings

About the role

Key responsibilities & impact

Conduct and support investigations and audits involving suspected healthcare fraud and potentially fraudulent claim activity
Analyze claims, investigative findings, audit results, and other relevant information to identify patterns, discrepancies, and potential fraud
Prepare written investigative summaries, findings, and recommendations
Develop evidence packages for contract holders, state insurance fraud bureaus, and law enforcement agencies
Lead on-site inspections and conduct patient and provider interviews as needed
Respond to subpoenas and information requests from law enforcement agencies and state Departments of Insurance
Represent the company as a witness in judicial proceedings when appropriate
Support special projects involving fraud detection, healthcare investigations, claims auditing, and SIU activities
Prepare reports and documentation to support tracking and reporting of investigations

Requirements

What you’ll need

3+ years of experience in health insurance investigations and/or auditing
Strong investigative and analytical skills
Ability to evaluate information and clearly document findings
Excellent verbal and written communication skills
Proficiency with Microsoft Excel, Access, and Word
Bachelor’s degree in Criminal Justice or a related field (preferred)
Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) credential (preferred)
Experience with healthcare claims, provider investigations, fraud detection, or Special Investigations Units (preferred)
Role supports the U.S. Commercial Healthcare business

Benefits

Comp & perks

Annual bonus plan eligibility
Medical, vision, and dental benefits starting day one
Well-being and behavioral health programs
401(k)
Company-paid life insurance
Tuition reimbursement
Minimum of 18 days of paid time off per year
Paid holidays
Leaves of absence
Remote work from home, subject to cable broadband or fiber optic internet service of at least 10Mbps download/5Mbps upload