Payment Integrity Quality Review and Audit Operations Specialist
hace 3 semanas
About the Role
We are seeking a highly skilled Payment Integrity Quality Review and Audit Associate Analyst to join our team. As a key member of the Payment Integrity Team, you will play a critical role in supporting Cigna's affordability commitment within Cigna International's business.
Key Responsibilities
• Identify and prevent fraudulent, wasteful, and abusive expenses from around the globe
• 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
- Identifying internal operational errors to prevent incorrect payments
- Conducting electronic outreach to providers requesting documents and confirming information
- Occasional telephonic outreach to providers in local regions to negotiate savings
- Verifying charges and services
- Partnering with other areas within Payment Integrity to share best practices
- Analyzing data on prior payments to identify additional opportunities
- Participating in projects to improve business processes
Qualifications
• Demonstrated strong organizational skills
• Strong attention to detail
• Ability to quickly learn new and complex tasks and concepts
• Competency in processing or investigating claims on either Mainframe, Diamond, or GlobalCare claim platforms
• Fluency in foreign languages in addition to fluent English is a strong plus
• Data analysis and reporting skills preferred
• Inquisitive nature capable of thinking critically and challenging assumptions
• Demonstrated follow-through on complex problems and tasks
• Comfortable working independently and with a team
• Ability to balance multiple priorities at once and deliver on tight timelines
• Ability to stay up to date on operations workflows
• Ability to develop and effectively communicate presentations and training materials
• Strong written and verbal communication skills
• Patience and creativity among key strengths
• Proficiency with Microsoft Excel required, with Word, PowerPoint, Outlook, and SharePoint preferred
• Experience processing international claims preferred
• Comfort with telephonic outreach to global entities preferred
Competencies
• Learning and applying quickly
• Organizing
• Priority Setting
• Problem Solving
• Interpersonal Savvy
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 healthcare system, empowering them with the information and insight they need to make the best choices for improving their health and vitality.-
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