Fraud Analyst – Payment Integrity, Global MIU

Cigna Health and Life Insurance Company; Kuala Lumpur; On-site; MYR 67,000 - 112,000; Full time

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Fraud investigation

Healthcare claims

Data analytics

Communication

Regulatory knowledge

Team collaboration

Time management

Education

Medical/paramedical qualification

Tools

Microsoft Excel

Claims processing systems

Job description

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.