Healthcare Fraud Investigator-Remote
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Job Location:
Bloomfield, CT - USA
Monthly Salary:
Not Disclosed
Posted on:
3 days ago
Vacancies:
1 Vacancy
Job Summary
Healthcare Fraud Investigator:
Make an impact protecting customers data and healthcare integrity.
Were looking for a skilled and motivated Healthcare Fraud Investigator to handle complex healthcare fraud matters that impact our customers and the this role youll take ownership of investigations from start to finishusing sound judgment analytic thinking and collaboration to bring cases to resolution.
This is an opportunity for investigators who enjoy digging into details following the data and working on highvalue cases that truly matter.
What Youll Do
- Lead indepth investigations into suspected or confirmed healthcare fraud using a thoughtful and independent investigative approach.
- Gather analyze and synthesize information from a variety of sources including claims data records interviews and internal partners.
- Manage complex highdollar investigations with a high degree of autonomy.
- Prepare clear welldocumented investigative reports and evidence packages to support case resolution recovery efforts or external referrals.
- Coordinate with internal stakeholders and when appropriate local state or federal agencies to support investigations.
- Respond to subpoenas or regulatory inquiries and provide testimony when required in partnership with legal and compliance teams.
- Support special projects related to fraud detection auditing and continuous improvement of investigative practices.
- Protect sensitive customer and company information including PHI while maintaining strict confidentiality standards.
What Youll Bring
- Bachelors degree in Criminal Justice or 7 years of investigative claims experience
- 3 years of healthcare fraud investigation SIU audit payment integrity or related experience.
- Proven ability to manage complex investigations independently and bring them to resolution.
- Strong analytical and computer skills with proficiency in Microsoft Excel Word and similar tools.
- Excellent written and verbal communication skills including the ability to present findings clearly and professionally.
- Comfort working with sensitive confidential information and exercising sound judgment.
- Ability to adapt to changing priorities and work effectively in a fastpaced environment.
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 need a reasonable accommodation to complete the online application process please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
About Company
Cigna Healthcare offers health insurance plans such as medical and dental to individuals and employers, international health insurance, and Medicare coverage.
