Internal Fraud Senior Analyst

hace 6 meses

Madrid, España The Cigna Group A tiempo completo

**Internal Fraud Senior Analyst - Payment Integrity FWA**

The job profile for this position is Financial Audit Fraud Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.

**Excited to grow your career?**

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply Our people make all the difference in our success.

**Role Summary**:
As Internal Fraud Senior Analyst within Payment Integrity FWA Team you will contribute towards the prevention and detection of fraud perpetrated against Cigna International or its clients and customers. You will be directly responsible for identifying and articulating risks and control weaknesses and providing clear constructive recommendations for improvements based upon the finding of your analytical based investigations. He/She will work closely with Data Analytics, Claims Operations, Finance and Accounting, Legal and Compliance, and Ethics teams.

**Responsibilities**:

- Provide a professional and efficient investigative capability, conducting data validation and initial investigations into suspected criminal activity or significant breaches of policy or process before passing to the relevant internal investigations teams.
- Identify scenarios of potential financial losses and reputation damage risk resulting from internal fraud and create analysis to test for the presence of such risks.
- Write or partner with Data Analytics team to test, and promote new rules to mitigate adverse fraud trends.
- Support management in the preparation of relevant data required to support new initiatives or business cases.
- Implement tactical changes to detection system rules.
- Recommend policy, process and procedural change evaluating impact on fraud operations.
- Assist in the evaluation and development of new fraud systems / tools.
- Ensure detection and prevention activities are being tracked and reported accurately.
- Extrapolate lessons learned from fraud investigations & suggest new data sources that would help in fraud detection.
- Recommend changes in standard operating procedures in order to mitigate internal fraud risk and participate in projects to improve business protocols, raise awareness of the internal fraud within the organisation and establish a policy on disclosure of information.
- Responsible for documenting and maintaining standard operating protocols (SOPs) related to internal fraud risk management operated by Payment Integrity.
- Provide ongoing operational analysis of process components, while identifying and implementing changes as necessary to improve the level of quality and efficiency as measured by key performance indicators.
- Provide reports to internal and external stakeholders on detection and prevention metrics.
- Working closely with other departments to ensure Payment Integrity activities do not have an unnecessary negative impact on our customers.

**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 in internal fraud detection.
- Experience in business intelligence and data analytics. Tableau Software knowledge is preferred.
- Experience and confidence in liaising with internal and external stakeholders.
- Commercial experience operating effectively under pressure and delivering results.
- Knowledge of Mainframe, Diamond, Actisure and/or Globalcare is essential.
- Good working knowledge of HR Policies.
- Critical mind-set with ability to understand procedural, regulatory and legal context.
- Demonstrated strong organization skills.
- Strong attention to detail.
- Ability to quickly learn new and complex tasks and concepts.
- 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.
- Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines.
- Dedicated to meeting the expectations and requirements of internal and external customers, excellent at building effective relationships and gaining trust and respect.
- Fluency in foreign languages in addition to fluent English is a strong plus.

**About The Cigna Group**

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.

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