Fraud Analyst

hace 4 semanas

Pozuelo de Alarcón Madrid provincia, España The Cigna Group A tiempo completo

**Fraud Analyst**

The job profile for this position is Fraud Analyst, which is a Band 2 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 Fraud Analyst within Payment Integrity Team you will be directly supporting Cigna’s affordability commitment within Cigna International's business. This role is responsible for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring within a dedicated region (Americas geography, dedicated to the GIH Book of Business). He/She will work closely with other PI team members, Network, Data & Analytics, Claims Operations, Clinical partners, Product and Member Investigation Unit (MIU).

**Responsibilities**:

- Investigate potential instances of fraud, waste or abuse (FWA) across Cigna’s International Markets books of business for claims incurred in a dedicated region.
- Ensure PI savings are tracked and reported accurately.
- Negotiation with providers contracted by Cigna or out-of-Network providers.
- Review existing cases for any FWA trends and patterns
- Partner with Cigna TPAs on provider investigations.
- Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
- Partner with Data Analytics team in building future FWA triggers automation.
- Review FWA tools to support in identification of cases along side senior investigators
- Adhere to turn around times and timelines on investigations
- Contact providers and members requesting documents and confirming information.
- Work with team members and manager to develop FWA cases

**Skills and Requirements**:

- Working knowledge of GIH claims processes and systems
- You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best.
- Experience of fraud investigation strongly desired.
- Minimum of 2 years of health insurance or health care provider experience.
- Knowledge of claims coding, regulatory rules and medical policy.
- Medical/ paramedical qualification is a definite plus.
- Critical mind-set with ability to identify cost containment opportunities.
- Experience with data analytics tool(s) is a strong asset.
- Excellent verbal and written communication, interpersonal and negotiation 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.
- Hybrid work location

**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._

  • Fraud Analyst

    hace 4 meses

    28223 Pozuelo de Alarcón, Madrid provincia, España The Cigna Group A tiempo completo

    **Fraud Analyst (Pre-Pay)** The job profile for this position is Fraud Audit Analyst (Pre-Pay), which is a Band 2 Senior Contributor Career Track Role. **Role Summary**: As a Fraud Analyst (Pre-Pay), within the Payment Integrity Department you will be directly supporting Cigna’s affordability commitment within Cigna International's business. This role is...

  • Fraud Analyst

    hace 6 meses

    Madrid, España Accertify A tiempo completo

    Accertify is the trusted partner to the world's leading brands. With industry-leading fraud prevention, chargebacks, and account protection offerings, we help our clients grow revenue and protect against loss. When you join Accertify, you become part of the digital solution that enables commerce across the globe. Team Accertify provides a solution merchants...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    .Fraud Analyst The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    .Fraud Analyst The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst Intern

    hace 4 semanas

    Madrid, Madrid, España Spotahome A tiempo completo

    About the Role">We are seeking a talented Fraud Analyst Intern to join our team in Madrid. As a Fraud Analyst Intern, you will be responsible for managing payment disputes, conducting fraud prevention investigations, and implementing KYC protocols.">What You Will Do">">Payment Disputes: You will learn about our operations and how to manage specific...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    .Fraud AnalystThe job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna Insurance A tiempo completo

    .The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    Fraud Analyst The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 3 semanas

    Madrid, España Cigna A tiempo completo

    Fraud Analyst The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    Fraud AnalystThe job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 3 semanas

    Madrid, España Cigna A tiempo completo

    Fraud AnalystThe job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 3 semanas

    Madrid, España Cigna A tiempo completo

    Fraud AnalystThe job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    Fraud Analyst The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 7 meses

    Madrid, España Malthusdarwin A tiempo completo

    Malthus Darwin es una empresa de Consultoría, especializada en la búsqueda, selección y evaluación de perfiles IT. Nuestro principal objetivo es proporcionar los mejores recursos humanos a nuestros clientes con la mayor rapidez y la máxima eficacia ofreciendo siempre un servicio de calidad.Actualmente estamos buscando un perfil de Fraud Analyst para dar...

  • Fraud Analyst

    hace 4 meses

    Madrid, España Malthusdarwin A tiempo completo

    Malthus Darwin es una empresa de Consultoría, especializada en la búsqueda, selección y evaluación de perfiles IT. Nuestro principal objetivo es proporcionar los mejores recursos humanos a nuestros clientes con la mayor rapidez y la máxima eficacia ofreciendo siempre un servicio de calidad.Actualmente estamos buscando un perfil de Fraud Analyst para dar...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España Cigna A tiempo completo

    The job profile for this position is Fraud Analyst, which is a Band 2 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...

  • Fraud Analyst

    hace 4 semanas

    Madrid, España CIGNA Insurance A tiempo completo

    The job profile for this position is Fraud Analyst, which is a Band 2 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,...

  • Sr Fraud Risk Analyst

    hace 4 semanas

    Madrid, España Scalapay A tiempo completo

    .Thanks to our innovative BuyNow PayLater payment solution, Scalapay is transforming the way more than 6.5 million customers buy online and in-store, empowering 8,000+ merchants (online and in-store) to give their customers magical shopping experiences.Being only 3 years old didn't stop us from becoming a unicorn. We have raised over $700mln and we did this...

  • Fraud Analyst

    hace 6 meses

    Madrid, España Amex A tiempo completo

    **You Lead the Way. We’ve Got Your Back.** With the right backing, people and businesses have the power to progress in incredible ways. When you join Team Amex, you become part of a global and diverse community of colleagues with an unwavering commitment to back our customers, communities and each other. Here, you’ll learn and grow as we help you create...