Risk Management Professional
hace 4 días
Fraud Analyst Job Profile
Company OverviewCigna Healthcare is an advocate for better health through every stage of life. Our mission is to empower individuals with the information and insight they need to make informed decisions about their health.
About the RoleWe are seeking a highly skilled Fraud Analyst to join our Payment Integrity Team in the Americas geography. This role will be responsible for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring.
Main 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.
- Negotiate with providers contracted by Cigna or out-of-Network providers.
- Review existing cases for any FWA trends and patterns.
- Working knowledge of GIH claims processes and systems.
- Minimum of 2 years of health insurance or health care provider experience.
- Knowledge of claims coding, regulatory rules and medical policy.
- Critical mindset with ability to identify cost containment opportunities.
- Experience with data analytics tool(s) is a strong asset.
You should have a strong analytical mind and excellent communication skills. Experience in fraud investigation is strongly desired. A medical/paramedical qualification is also a plus.
What We OfferWe offer a competitive salary range of $75,000 - $90,000 per annum, depending on experience. In addition to your salary, you will receive a comprehensive benefits package that includes health insurance, retirement plans, and paid time off.
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