Fraud Analyst (Pre-Pay) – Global Payments & FWA

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

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.