Fraud Analyst - Cigna Healthcare

Cigna Health and Life Insurance Company; Madrid; On-site; EUR 36,000 - 58,000; Full time

Job summary

Cigna Health and Life Insurance Company is seeking a Fraud Analyst (Pre-Pay) to join the Payment Integrity team. In this Band 2 Senior Contributor role, you will help identify and prevent fraudulent, wasteful and abusive expenses worldwide and support client reporting.

You will work with global teams, review claims for potential fraud, request documents from providers, and contribute to process improvements and future FWA trigger automation.

Qualifications

• Experience of fraud investigation strongly desired.
• Minimum of 2 years of health insurance or health care provider experience.
• Competent in processing or investigating claims on Diamond.
• Knowledge of claims coding, regulatory rules and medical policy.
• Medical/ paramedical qualification is a definite plus.
• Demonstrated strong organization skills.
• Strong attention to detail.
• Ability to quickly learn new and complex tasks and concepts.
• Fluency in foreign languages is a strong plus.

Responsibilities

• Manages Team mailbox and responds or directs enquiries appropriately.
• Acts as initial review point for (possible) fraudulent claims.
• Identifying claims with potential waste and abuse
• Provides initial review and research to help determine if claims require further investigation to determine possible fraudulent activity.
• Contact providers requesting documents and confirming information.
• Uphold documentation and process standards
• Partner with cost containment teams in other geographies to share best practices.
• Participate in projects to improve business processes.
• Ensure team savings are tracked and reported accurately.
• Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
• Partner with Data Analytics team in building future FWA triggers automation.
• Support the production of investigation reports to internal and external stakeholders by compiling and storing evidence appropriately.

Skills

Fraud investigation

Health insurance

Diamond claims

Claims coding

Medical policy

Organization skills

Attention to detail

Multitasking

Communication skills

Time management

Global teams

Foreign languages

Education

Health care experience

Tools

Diamond system

Job description

Job Description Fraud Analyst (Pre-Pay)

The job profile for this position is Fraud 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 responsible for identifying and preventing fraudulent, wasteful and abusive expenses from around the globe and supporting the Payment Integrity FWA Team with client reporting.

Responsibilities

• Manages Team mailbox and responds or directs enquiries appropriately.
• Acts as initial review point for (possible) fraudulent claims.
• Identifying claims with potential waste and abuse
• Provides initial review and research to help determine if claims require further investigation to determine possible fraudulent activity.
• Contact providers requesting documents and confirming information.
• Uphold documentation and process standards
• Partner with cost containment teams in other geographies to share best practices.
• Participate in projects to improve business processes.
• Ensure team savings are tracked and reported accurately.
• Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
• Partner with Data Analytics team in building future FWA triggers automation.
• Support the production of investigation reports to internal and external stakeholders by compiling and storing evidence appropriately.

Skills and Requirements

• 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.
• Competent in processing or investigating claims on Diamond.
• Knowledge of claims coding, regulatory rules and medical policy.
• Medical/ paramedical qualification is a definite plus.
• Demonstrated strong organization skills.
• Strong attention to detail.
• Ability to quickly learn new and complex tasks and concepts.
• Critical mind-set with ability to identify cost containment opportunities.
• Excellent verbal and written communication 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.

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.

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.