Healthcare Fraud Investigator Case Development
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Job Location:
Bloomfield, CT - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Join a specialized Special Investigations (SIU) referral and case enhancement team focused on identifying and mitigating healthcare this role youll use your investigative experience and datadriven insights to assess suspected fraud referrals uncover highrisk billing patterns and guide meaningful investigations that protect patients and reduce financial risk for clients and customers.
Responsibilities
- Independently research analyze and assess suspected healthcare fraud referrals using investigative techniques and data analysis.
- Identify highrisk billing behaviors fraud trends and potential overpayments through detailed data review.
- Evaluate referrals submitted to SIU and determine whether allegations warrant full investigation.
- Deliver clear wellstructured case assessments with actionable investigative recommendations.
- Partner closely with investigators and field staff to develop leads and refine investigative strategies.
- Use technology and analytics to support complex investigations and adapt investigative direction as new information emerges.
- Monitor industry alerts regulatory updates and fraud bulletins to assess potential exposure.
- Handle sensitive and confidential information with integrity and professionalism.
Qualifications
Required
- 3 years of experience in healthcare insurance investigation audit or relevant experience
- Strong analytical research and problemsolving skills
- Clear and concise written and verbal communication skills
- Proficiency with Microsoft Excel and Word
Preferred
- Bachelors degree in Criminal Justice or related field
- AHFI and/or CFE certification
- CPT and ICD10 coding knowledge
- Experience working with data analytics tools and investigative databases
If you will be working at home occasionally or permanently the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position we anticipate offering an annual salary of 68300 - 113900 USD / yearly depending on relevant factors including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus 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
Doing something meaningful starts with a simple decision a commitment to changing lives. At The Cigna Group were 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.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.
Key Skills
- Risk Management
- Bank Secrecy Act
- Fraud
- PCI
- Law Enforcement
- Banking
- Business Management
- Regulatory Reporting
- Analysis Skills
- Customer Support
- UCC Law
- RMF
About Company
Cigna Healthcare offers health insurance plans such as medical and dental to individuals and employers, international health insurance, and Medicare coverage.
