Remote Prepay Fraud & Audit Supervisor

Cigna Healthcare; Kuala Lumpur; On-site; MYR 120,000 - 160,000; Full time

Job summary

Cigna Healthcare, a division of The Cigna Group, seeks a Quality Review and Audit Prepay Supervisor to lead a regional prepayment team focused on identifying non-payable claims and Fraud, Waste and Abuse savings within international markets.

The role involves coordinating with PI, Network, Data Analytics, Claims Operations, and MIU to drive adherence to policies and improve processes, while managing remote staff and delivering KPI targets.

Qualifications

• 2+ years health insurance or international health care provider experience.
• 1+ year experience in a Payment Integrity function preferred.
• Fluency in languages beyond English is a strong plus.
• Data analysis and reporting skills preferred.
• Experience processing international claims preferred.
• Comfortable working with remote/global teams.

Responsibilities

• Lead the Regional Prepayment team who identify claims that should not be paid as received and identify Fraud, Waste and Abuse savings.
• Collaborate with PI management to execute departmental plans and priorities.
• Manage internal stakeholder relationships.
• Coach team to monitor non-compliance in billing and claims within international markets.
• Ensure KPIs are met and PI savings are tracked and reported.
• Drive strategic initiatives aligned with KPIs and financial targets.
• Ensure payment integrity processes comply with legal/regulatory requirements.
• Assess workload vs capacity to optimize claim referrals and timeliness.
• Foster a culture of continuous process improvement, innovation, and quality.
• Oversee personnel matters and conduct performance appraisals for team members.
• Assist onboarding and training of new hires.
• Negotiate with providers and review services and charges as needed.
• Provide input to policy changes to mitigate risk and improve protocols.
• Contribute to workforce planning and resource management.
• Communicate feedback to other departments to reduce risk exposure.

Skills

Organization skills

Attention to detail

Learn quickly

Claims processing systems

Health insurance experience

Payment Integrity experience

Foreign languages

Medical terminology

Data analysis

Critical thinking

Independent work

Team collaboration

Time management

Microsoft Excel

SharePoint

PowerPoint

Tools

GlobalCare

Actisure

Excel

SharePoint

PowerPoint

Word

Job description

Cigna Healthcare, a division of The Cigna Group, seeks a Quality Review and Audit Prepay Supervisor to lead a regional prepayment team focused on identifying non-payable claims and Fraud, Waste and Abuse savings within international markets.

The role involves coordinating with PI, Network, Data Analytics, Claims Operations, and MIU to drive adherence to policies and improve processes, while managing remote staff and delivering KPI targets.