Fraud Analyst - Cigna Healthcare

Cigna Health and Life Insurance Company; Kuala Lumpur; Presencial; MYR 67.000 - 112.000; Tempo integral

Resumo da vaga

Cigna Health and Life Insurance Company in Kuala Lumpur invites a Fraud Analyst – Payment Integrity MIU to join a global team. You will detect and recover fraudulent or abusive payments, help prevent overpayments, and monitor spend across international markets.

The role emphasizes data mining, collaboration with TPAs, and delivering investigation reports to stakeholders. A healthcare claims background and familiarity with claims coding and medical policy are highly valued.

Qualificações

• Experience of fraud investigation within Healthcare or similar discipline strongly desired.
• Minimum of 2 years of health insurance claims experience or health care provider experience.
• Knowledge of claims coding, regulatory rules and medical policy.

Responsabilidades

• Identify and investigate potential instances of fraud, waste or abuse (FWA) across all markets for claims incurred.
• Seek recovery of FWA payments from claim submissions.
• Ensure savings are tracked and reported accurately.
• Implement solutions to prevent claims overpayment and unnecessary spend, while ensuring timely PI reviews.
• Perform data-mining to reveal FWA trends and patterns.
• Partner with Cigna TPAs on FWA investigations.
• Collaborate with Payment Integrity teams in other locations to share schemes.
• Provide investigation reports to internal and external stakeholders.

Conhecimentos

Fraud investigation

Healthcare claims

Data analytics

Communication

Regulatory knowledge

Team collaboration

Time management

Formação

Medical/paramedical qualification

Ferramentas

Microsoft Excel

Claims processing systems

Descrição da vaga

Fraud Analyst –Payment Integrity Member Investigation Unit

The job profile for this position is Fraud Analyst –Payment Integrity Member Investigation Unit (MIU), which is a Band 2 Senior Contributor Career Track Role.

Role Summary:

As Fraud Analyst within the Member Investigation Unit (MIU) you will be directly supporting Cigna’s affordability commitment within Cigna International's business. This role is responsible for detecting and recovering fraudulent, waste or abusive (FWA) payments, creating solutions to prevent claims overpayment and future spend monitoring. He/She will work closely with other Payment Integrity (PI) team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners and Product.

Responsibilities:

• Identify and Investigate potential instances of fraud, waste or abuse (FWA) across all Cigna’s International Markets books of business for claims incurred.
• Seek recovery of FWA payments from claim submissions.
• Ensure savings are tracked and reported accurately.
• Work in partnership to implement solutions and drive execution to prevent claims overpayment, unnecessary claim spend, and ensure timeliness and accuracy of PI claims review process.
• Perform data-mining to reveal FWA trends and patterns.
• Partner with Cigna TPAs on FWA investigations.
• Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
• Partner with Data Analytics team in building future FWA triggers automation.
• Provide investigation reports to internal and external stakeholders.

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 within Healthcare or similar discipline strongly desired. Minimum of 2 years of health insurance claims experience or health care provider experience. Knowledge of claims coding, regulatory rules and medical policy. Medical/ paramedical qualification is a definite plus. Critical mind-set with ability to identify cost containment opportunities. Experience with data analytics is a strong asset. Strong attention to detail. Excellent verbal and written communication skills. Flexibility to work with global teams and varying time zones effectively. Confidence to liaise with internal stakeholders. Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines. Experience of full Microsoft suite. Fluency in foreign languages in addition to fluent English is a strong plus.

About The Cigna Group

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. 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.