Senior Fraud & Payment Integrity Lead (Hybrid)

Es3 Esp Cigna European Services; Glasgow; Hybrid; GBP 70,000 - 95,000; Full time

Benefits offered by this job

Hybrid working model

Competitive benefits package

Job summary

Cigna Healthcare, part of The Cigna Group, seeks a Fraud Senior Supervisor to lead the Member Investigation Team within the International Business Market. You will drive investigations into suspected member fraud, support profitability, and partner with Client Management Teams to ensure compliance and effective risk control.

You will oversee KPI performance, coach investigators, and work with multiple departments to optimize payment integrity, while maintaining data integrity and strong client

Qualifications

• Experience of leading operational teams.
• 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 with strong relationship-building.
• Knowledge of medical terminology and treatment modalities.
• Critical thinking with cost containment focus.
• Strong reporting and analytical skills with reporting pack development.
• Experience with data analytics tools is a strong asset.
• Excellent verbal and written communication, interpersonal and negotiation skills.
• Ability to balance multiple priorities under tight timelines.
• Flexibility to work with global teams and varying time zones.
• Fluency in foreign languages is a plus.

Responsibilities

• Lead the Member Investigation Team to identify and prevent fraudulent, wasteful and abusive expenses while meeting targets and KPIs.
• Collaborate with PI FWA senior management to execute strategic plans.
• Represent Payment Integrity when engaging with external clients and communicate fraud risks.
• Manage internal stakeholder relationships and mentor investigators.
• Ensure compliance with SOPs and guidelines across investigations.
• Monitor KPIs and ensure PI savings are tracked and reported.
• Drive strategic initiatives aligned with KPIs and financial targets.
• Utilize BI and data analytics to monitor regional claim patterns and improve PI rulesets.
• Ensure regulatory, legal and contractual compliance of PI processes.
• Act with urgency during elevated fraud risk and maintain professional client communications.

Skills

Team leadership

Counter fraud

Health insurance experience

Risk management

Regulatory knowledge

Data analytics

Communication skills

Project management

Time management

Cross-timezone collaboration

Education

Accredited counter fraud qualification

Job description

Cigna Healthcare, part of The Cigna Group, seeks a Fraud Senior Supervisor to lead the Member Investigation Team within the International Business Market. You will drive investigations into suspected member fraud, support profitability, and partner with Client Management Teams to ensure compliance and effective risk control.

You will oversee KPI performance, coach investigators, and work with multiple departments to optimize payment integrity, while maintaining data integrity and strong client