Fraud & Payment Integrity Senior Lead (International)

Cigna Healthcare; Madrid; Híbrido; EUR 70.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Hybrid working model

Competitive benefits package

Flexible working hours

Descripción de la vacante

Cigna Healthcare in Madrid seeks a Fraud Senior Supervisor to lead the Member Investigation Team within the Payment Integrity function. The role focuses on detecting and recovering FWA, guiding investigators, and ensuring adherence to regulatory requirements while collaborating with internal stakeholders.

You will leverage data analytics to monitor claim patterns, report KPIs, and drive improvements in investigation quality and timeliness.

Formación

• Experience leading operational teams in health insurance or international health care.
• Accredited counter fraud qualification required.
• Strong analytical and reporting skills with data analytics experience.

Responsabilidades

• Lead the Member Investigation Team to identify and prevent fraudulent, wasteful and abusive expenses.
• Represent the Payment Integrity function in client engagements and report fraud risks to clients.
• Ensure KPIs are met and PI savings are tracked and reported.
• Coach and guide investigators to ensure compliance with SOPs.
• Monitor risk and regulatory compliance across investigations and liaise with analytics teams.
• Drive process improvements and develop FWA rulesets with Data & Analytics.

Conocimientos

Team leadership

Fraud detection

Regulatory knowledge

Analytical skills

Stakeholder management

Educación

Accredited counter fraud qualification

Descripción del empleo

Cigna Healthcare in Madrid seeks a Fraud Senior Supervisor to lead the Member Investigation Team within the Payment Integrity function. The role focuses on detecting and recovering FWA, guiding investigators, and ensuring adherence to regulatory requirements while collaborating with internal stakeholders.

You will leverage data analytics to monitor claim patterns, report KPIs, and drive improvements in investigation quality and timeliness.