Fraudulent Expense Prevention and Recovery Specialist
hace 4 semanas
Payment Integrity Quality Review and Audit Specialist
Cigna International's Payment Integrity Team is seeking a skilled Quality Review & Audit Associate Analyst to directly support the company's affordability commitment. This crucial role involves identifying and preventing fraudulent, wasteful, and abusive expenses from around the globe.
The ideal candidate will perform a variety of prepay-focused cost avoidance activities, including:
- Identifying suspicious activity and submitting it to the designated FWA and SIU team for investigation
- Internal operational error identification to prevent incorrect payments
- Electronic outreaches to providers requesting documents and confirming information
- Occasional telephonic outreach to providers in local regions to negotiate savings and verify charges
This role requires close collaboration with the Payment Integrity Team to efficiently utilize each individual's strengths and work closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers. Additionally, the candidate will provide feedback to other departments to implement safeguards and prevent further risk exposure.
To be successful in this position, the candidate should possess:
- Strong organization skills
- Attention to detail
- Ability to quickly learn new and complex tasks and concepts
- Competence in processing or investigating claims on Mainframe, Diamond, or GlobalCare claim platforms
- Fluency in foreign languages is a strong plus
- Data analysis and reporting skills are preferred
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. Our team empowers customers with the information and insight needed to make informed health choices.
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