Fraud Analyst – Payment Integrity

Fraud Analyst Payment Integrity Global Investigation Unit

The job profile for this position is Fraud AnalystPayment Integrity Global Investigation Unit which is a Band 2 Senior Contributor Career Track Role.

Excited to grow your career

We value our talented employees and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you we encourage you to apply! Our people make all the difference in our success.

Role Summary:

As Fraud Analyst within the Global Investigation Unit you will be directly supporting Cignas affordability commitment within Cigna Internationals business. This role is responsible for detecting and recovering fraudulent waste or abusive (FWA) payments creating solutions to prevent claims overpayment and future spend monitoring. He/She will work closely with other Payment Integrity (PI) team members Network Medical Economics Data Analytics Claims Operations Clinical partners and Product.

Responsibilities:

• Identify and investigate potential instances of fraud waste or abuse (FWA) across claims and payment card activity driving timely consistent decision-making and effective investigation outcomes.

• Conduct transaction monitoring analytical reviews and data mining to identify unusual patterns anomalies and emerging FWA risks across cardenabled claims and transactions.

• Manage chargeback activity and recovery outcomes where inappropriate payments are identified ensuring savings are accurately tracked and reporting is clear and timely.

• Partner with operational teams to configure strengthen and monitor payment integrity controls contributing to continuous improvement of workflows to enhance accuracy efficiency and timeliness.

• Provide investigation reports to internal and external stakeholders.

• Partner with Payment Integrity teams in other locations to share FWA claiming schemes.

• Partner with Data Analytics team in building future FWA triggers automation.

• Partner with Cigna TPAs on FWA investigations.

• Proactively monitor industry information bulletins to assess impact to the company.

Skills and Requirements:

• Minimum of 2 years experience in fraud investigation payment integrity card fraud or a related discipline.

• Minimum of 2 years experience in health insurance claims processing health care provider operations or similar environment.

• Strong understanding of payment card ecosystems dispute and chargeback processes and fraud typologies with demonstrated capability in transactionlevel analysis and application of risk controls.

• Experience with data analytics and investigative use of data is a strong asset

• Strong analytical mindset mind-set with ability to identify cost containment opportunities.

• High attention to detail with the ability to produce accurate welldocumented investigative outputs.

• Excellent verbal and written communication skills with confidence engaging internal stakeholders and external partners.

• Knowledge of claims coding regulatory requirements and medical policy preferred.

• Medical/ paramedical qualification is an advantage.

• Flexibility to work with global teams and varying time zones effectively.

• Strong organization skills with the ability to manage competing priorities and work effectively under pressure to meet tight deadlines.

• Proficient in the full Microsoft suite.

• Fluency in additional languages beyond English is a strong plus.

• Enjoys working in a high-performing collaborative team environment with shared accountability for outcomes.

About Cigna Healthcare

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.