Payment Integrity Quality Review and Audit Associate Analyst

hace 6 días

Madrid, Madrid, España The Cigna Group A tiempo completo

Quality Review Audit Associate Analyst

As a Quality Review & Audit Associate Analyst working on the Payment Integrity Team you will be directly supporting Cigna's affordability commitment within Cigna International's business.

Your responsibilities will include:


• Identifying and preventing fraudulent, wasteful and abusive expenses from around the globe


• Perform a variety of prepay focused cost avoidance activities including:

o Identifying suspicious activity and submission to the designated FWA and SIU team for investigation

o Identifying internal operational errors to prevent incorrect payment being made

o Electronic outreaches to providers requesting documents and confirming information

o Occasional telephonic outreach to providers in local region to negotiate

savings

o Verification of charges and services

o Partner with other areas within Payment Integrity to share best practices

o Analyze data on prior payments to identify additional opportunities

o Participate in projects to improve business processes


• Working collaboratively in a team environment to efficiently utilize each individual's strengths


• Working closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers


• Providing feedback to other departments in order to put in place safeguards to prevent further risk exposure

Qualifications


• Demonstrated strong organization skills


• Strong attention to detail


• Ability to quickly learn new and complex tasks and concepts


• Competent in processing or investigating claims on either Mainframe, Diamond or GlobalCare claim platforms


• Fluency in foreign languages in addition to fluent English is a strong plus


• Data analysis and reporting skills preferred


• Inquisitive nature capable of thinking critically and challenging assumptions


• Demonstrated follow through on complex problems and tasks


• Comfortable working independently and with a team


• Ability to balance multiple priorities at once and deliver on tight timelines


• Ability to stay up to date on operations workflows


• Ability to develop and effectively communicate presentations and training

materials


• Strong written and verbal communication skills


• Patience and creativity amongst your strong points


• Proficiency with Microsoft Excel needed. Word, PowerPoint, Outlook, and SharePoint preferred


• Experience processing international claims preferred


• Comfort with telephonic outreaches to global entities preferred

Competencies


• Learning and applying quickly


• Organizing


• Priority Setting


• Problem Solving


• Interpersonal SavvyExperience processing international claims preferred
• Comfort with telephonic outreaches to global entities preferred Competencies
• Learning and applying quickly
• Organizing
• Priority Setting
• Problem Solving
• Interpersonal Savvy

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.


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