Fraud Senior Supervisor

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

About Cigna

Cigna Healthcare, a division of The Cigna Group, is a global health services company dedicated to improving the health, wellbeing, and peace of mind of those we serve. Operating in over 30 countries, Cigna supports more than 190 million customer relationships worldwide through medical, dental, behavioral health, pharmacy, and vision care solutions.

Fraud Senior Supervisor

The job profile for this position is Fraud Senior Supervisor, which is a Band 3 Management Career Track Role.

Role Summary:

As a Fraud Senior Supervisor within the Member Investigation Unit you will be directly supporting Cigna’s affordability commitment within Cigna International’s business and have specific responsibility for the quality and effectiveness of investigations into suspected member behaviours. This role is responsible for managing a team accountable for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring. This role will partner with internal stakeholders and specifically Client Management Teams to demonstrate good practice anti-fraud services, compliance with global regulatory and legislative requirements and will maintain integrity of all investigative data and reports. He/ She will work closely with other PI team members, Medical Economics, Data & Analytics, Claims Operations, Clinical partners and Product.

Responsibilities:

• Lead the Member Investigation Team who are responsible for identifying and preventing fraudulent, wasteful and abusive expenses within Cigna’s International Business Market ensuring team targets and KPIs are met.
• Works closely with PI FWA senior management to understand strategy and is responsible for executing departmental plans and priorities.
• Responsible for representing the Payment Integrity function when engaging with external clients and reporting to and informing clients of their fraud risks.
• Accountable for managing internal stakeholder relationships.
• Coach, support and provide appropriate case guidance, to Investigators ensuring compliance with investigation standard operating models.
• Ensure department KPIs are met through effective monitoring and reporting mechanisms; ensure PI savings are tracked and reported accurately.
• Executes strategic initiatives, plans, and goals in alignment with department KPIs and financial targets.
• Effectively use business intelligence and data analytics to monitor PI FWA regional claim patterns and identify opportunities for PI intervention and liaises with the Data & Analytics team to develop FWA rulesets.
• Ensures Payment Integrity processes are in compliance with legal, regulatory and contractual requirements.
• Acts with urgency when there is an elevated risk of fraud against Cigna and its customers and clients.
• Ensures investigative findings are documented and that all communications with clients are fact based and professional.
• Assess work demand against capacity to ensure optimum claim referrals across all referral routes; create solutions, drive execution and ensure timeliness and accuracy of PI claims review process, loss prevention and recovery activity.
• Instils work culture of continuous process improvement, innovation, and quality.
• Oversee departmental personnel matters; evaluating staff performance and conducting performance appraisals for all direct reports. Ensure adherence to company practices and procedures.
• Recommends changes in policy and procedures in order to mitigate risk and participates in projects to improve business protocols.
• Provides input into workforce planning and recruitment activities and addresses resource and operational challenges.
• Working closely with other departments to ensure Payment Integrity activities do not have an unnecessary negative impact on our customers.

Skills and Requirements:

• Experience of leading operational teams. You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best
• An accredited counter fraud qualification.
• Minimum of 5 years of health insurance or international health care provider experience.
• Experience of operational risk management, including internal and external risk and compliance reporting.
• Knowledge of claims coding, regulatory rules and medical policy.
• Medical/ paramedical qualification is a definite plus.
• Customer Focus – dedicated to meeting the expectations and requirements of internal and external customers, excellent at building effective relationships and gaining trust and respect.
• Passive knowledge of medical terminology and treatment modalities.
• Critical mind-set with ability to identify cost containment opportunities.
• Strong reporting and analytical skills with ability to create and improve reporting packs and methodologies with some support.
• An experience with data analytics tool(s) is a strong asset.
• Excellent verbal and written communication, interpersonal and negotiation 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.

What We Offer

• The opportunity to work in a global, diverse and collaborative environment.
• Exposure to cross-functional teams and strategic projects.
• A culture that supports learning, development and internal career growth.
• A role with real impact on business performance and healthcare affordability.
• A supportive and inclusive workplace that values innovation and continuous improvement.
• A competitive benefits package, including a range of social benefits (location dependent).
• A hybrid working model and flexible working hours to support work-life balance.

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.