Managing Director, Special Investigations Unit

Key Responsibilities

Strategic Leadership & Enterprise Influence

• Provide strategic oversight of the Special Investigations Unit setting direction for fraud waste and abuse (FWA) prevention detection and investigative operations across multiple business segments.

• Align SIU strategy with enterprise objectives regulatory expectations and emerging industry risks ensuring Cigna maintains a leadership position in combating provider and member fraud.

• Collaborate with key internal and external partners to strengthen endtoend fraud controls.

• Prepare and present Annual Anti-Fraud plan including risks new and emerging schemes critical metrics and results.

Advanced Analytics AI & Data Infrastructure

• Apply deeper proactive analytics across multiple business lines by leveraging advanced modeling datamart assets automated detection tools and scalable analytic infrastructure to strengthen antifraud controls.

• Expand analytic toolsets by optimizing data pipelines integrating disparate data sources and ensuring analytic teams have access to modern tools methodologies and platforms.

• Ensure AI and machine learning capabilities are effectively leveraged to identify anomalous billing predictive risk patterns provider behavior changes and complex schemes earlier and more accurately.

Operational Excellence & Investigative Quality

• Oversee endtoend investigative processes ensuring consistency strong documentation adherence to regulatory requirements and application of best practices across all investigative teams.

• Consolidate disparate data to increase operational controls improve tracking of investigative steps and strengthen daytoday execution.

• Drive proactive resolution of provider billing issues and reduce repeat offenses through education corrective action and coordinated intervention strategies.

• Establish performance measures that reinforce quality timeliness investigative rigor and impact.

Talent Leadership Culture and Employee Engagement

• Lead through integrity and set a high standard of ethics accountability and transparency for the SIU organization.

• Enhance employee engagement strengthen culture and foster a sense of purpose within the SIU team by championing talent development retention recognition and engagement strategies.

• Optimize talent and retain high performers ensuring succession planning technical skill development and crossfunctional knowledge-sharing.

External Relationships Reporting and Business Partner Engagement

• Strengthen outwardfacing SIU reporting ensuring clients subsidiaries and regulators receive accurate timely and relevant fraudrelated insights.

• Initiate and lead new client subsidiary and vendor initiatives that expand the impact of Cignas antifraud work improve detection and prevention capabilities and reinforce Cignas value proposition in the marketplace.

• Serve as the enterprise spokesperson on FWA trends operational results strategic initiatives and emerging risks for senior leadership clients and external partners.

Governance Compliance & Risk Management

• Ensure SIU operations meet federal state and CMS requirements related to fraud waste and abuse programs.

• Maintain strong controls robust audit readiness and comprehensive documentation to support regulatory inquiries and enterprise risk mitigation.

• Partner with Legal and Compliance to ensure investigative activities reporting and corrective action plans are aligned with enterprise policies and industry standards.

Qualifications

Required:

• 12 years of increasing responsibility in fraud waste and abuse investigations audit or health care risk management including 5 years of people management experience

• Demonstrated leadership of multidisciplinary investigative and analytic teams across complex organizations.

• Deep understanding of CMS state regulatory commercial and government program FWA requirements.

• Deep understanding of health care industry practices

• Exceptional communication skills with the ability to influence senior leaders external partners and crossfunctional teams.

Preferred:

• Prior leadership of a large SIU or FWA function within a payer PBM government agency or major health care organization.

• Experience integrating AI/ML tools into investigative or operational workflows.

• Strong clientfacing experience including reporting vendor management or consultative support.

Leadership Competencies

• Strategic Vision & Execution Ability to anticipate industry shifts and guide the SIU to proactively address emerging fraud risks.

• Enterprise Collaboration Proven ability to work across functions to build trust alignment and shared accountability.

• Analytical Acumen Comfort operating in a datarich environment with a commitment to evidencebased decision making.

• Integrity & Ethics Consistent demonstration of sound judgment fairness and adherence to Cignas values.

• Talent Development Commitment to developing strong leaders and sustaining high-performing teams.

This role is also anticipated to be eligible to participate in an annual bonus and long term incentive plan.

At The Cigna Group youll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment youll be offered several health-related benefits including medical vision dental and well-being and behavioral health programs. We also offer 401(k) company paid life insurance tuition reimbursement a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs click here.

About The Cigna Group

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.

If you require reasonable accommodation in completing the online application process please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama Alaska Arizona Arkansas Delaware Florida Georgia Hawaii Idaho Iowa Kansas Maryland Massachusetts Michigan Nebraska Ohio Pennsylvania Texas Utah Vermont and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances.