Payment Integrity Quality Review and Audit Specialist

hace 1 semana


Madrid, Madrid, España The Cigna Group A tiempo completo

Quality Review and Audit Expertise

Cigna International's Payment Integrity Team seeks a skilled Quality Review and Audit Expert to support the company's affordability commitment. As a key member of this team, you will directly contribute to ensuring the accuracy and integrity of payment processes worldwide.

Key Responsibilities:

• Identify and prevent fraudulent, wasteful, and abusive expenses globally

• Collaborate with the Payment Integrity Team to implement prepay focused cost avoidance activities, including:• Investigating suspicious activity and submitting findings to the designated FWA and SIU team
• Identifying internal operational errors to prevent incorrect payments
• Conducting electronic outreaches to providers for document verification and information confirmation
• Participating in telephonic outreaches to providers in local regions for negotiations and savings verification

• Partner with other areas within Payment Integrity to share best practices and improve business processes

• Work collaboratively with teams to efficiently utilize individual strengths and expertise

• Engage with other departments to ensure activities do not negatively impact customers

• Provide feedback to departments to implement safeguards and prevent risk exposure

Qualifications:

• Demonstrated strong organizational skills and attention to detail

• Ability to quickly learn complex tasks and concepts

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

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

• Data analysis and reporting skills are preferred

• Inquisitive nature with the ability to think critically and challenge assumptions

• Demonstrated follow-through on complex problems and tasks

• Ability to balance multiple priorities and deliver on tight timelines

• Proficiency with Microsoft Excel and preferred proficiency in Word, PowerPoint, Outlook, and SharePoint

Competencies:

• Learning and applying quickly

• Organizing and prioritizing tasks

• Problem-solving and analytical skills

• Interpersonal savvy and collaboration skills



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