Global Director of Payment Integrity & Investigations

About Cigna Healthcare

At Cigna Healthcare we are committed to improving the health well-being and peace of mind of those we serve. As part of The Cigna Group we support millions of customers worldwide through innovative healthcare solutions global expertise and a relentless focus on delivering sustainable high-quality care.

Within Cigna International Health we help individuals families and organizations navigate healthcare across borders combining clinical excellence digital innovation and operational expertise to create exceptional experiences for our customers and partners around the world.

We are looking for leaders who share our passion for transforming healthcare driving meaningful impact and delivering better outcomes for customers clients and providers.

Position Summary

We are seeking an exceptional leader to build and advance the Payment Integrity and Investigations capability across Cigna International Health.

Reporting into senior leadership this role is accountable for protecting healthcare affordability strengthening payment accuracy preventing fraud waste and abuse and driving measurable financial and operational value across international markets.

The Director will define the strategic vision operating model and future roadmap for Payment Integrity bringing together data analytics clinical expertise investigations and technology to identify risk prevent leakage and deliver sustainable outcomes. This is a highly visible leadership position that offers the opportunity to influence enterprise-wide decisions partner with senior executives and shape one of the most critical affordability capabilities within Cigna International Health.

Key Accountabilities

Payment Integrity Strategy & Operating Model

• Own and execute the international Payment Integrity and Investigations strategy aligning priorities with affordability objectives business needs regulatory requirements and enterprise capabilities.

• Design and continuously evolve an integrated operating model spanning pre-payment controls post-payment review analytics investigations clinical and coding audit recovery and root-cause remediation.

• Establish a multi-year capability roadmap covering people process data technology governance and external partnerships with clear investment priorities and measurable outcomes.

• Define consistent standards decision rights escalation pathways and service expectations across global and regional teams while enabling appropriate local market execution.

• Position Payment Integrity as a strategic affordability risk management and value-creation capability supporting sustainable growth and a differentiated client proposition.

Pre-Payment Prevention & Post-Payment Review

• Lead the development and optimization of pre-payment edits clinical rules coding validations duplicate-payment controls tariff and contract checks and other interventions that prevent leakage before payment.

• Oversee post-payment analytics targeted audits claim reviews and data-mining activities to identify inappropriate payments emerging patterns and recovery opportunities.

• Ensure payment integrity concepts are evidence-based operationally executable and supported by robust testing documentation and change management processes.

• Partner with Claims Provider Operations Network Clinical Pharmacy Data Technology Partnerships and Controls teams to embed effective controls into end-to-end workflows.
• Drive root-cause analysis and sustainable remediation so identified issues result in improved upstream processes policies provider arrangements and system controls.

Investigations Fraud Waste & Abuse

• Lead the Special Investigations capability for suspected fraud waste abuse and error involving providers members intermediaries or other relevant parties.

• Establish risk-based case intake triage investigation evidence referral and closure standards that support consistent timely and defensible outcomes.

• Develop proactive detection models intelligence-led investigations provider profiling and network surveillance to identify complex or organized patterns of inappropriate activity.
• Partner closely with Compliance Legal Privacy Security Human Resources and external authorities on sensitive cases regulatory notifications sanctions and law enforcement referrals where appropriate.

• Maintain clear separation between allegation investigation and substantiated findings ensuring fairness confidentiality and procedural integrity throughout the case lifecycle.

Recovery Value Delivery & Performance Management

• Own the financial and operational performance of the function including prevention cost avoidance identified savings validated savings recoveries productivity quality cycle times and return on investment.

• Build a disciplined recovery strategy across providers members vendors and third parties while balancing financial value contractual rights provider relationships and customer experience.

• Establish transparent management information forecasting benefit validation and reporting standards that provide leadership with a reliable view of performance risks and delivery confidence.

• Prioritize initiatives and investigations based on value risk complexity likelihood of recovery regulatory exposure and strategic importance.

• Ensure savings methodologies are consistent auditable and aligned with Finance and business stakeholders.

Data Analytics & Technology Enablement

• Define the data and analytics strategy for Payment Integrity and Investigations including data quality governance model performance and actionable insight generation.

• Sponsor advanced analytics machine learning artificial intelligence and automation initiatives that improve detection prioritization investigator effectiveness and case conversion.

• Partner with Data Technology and Medical Economics teams to improve claims clinical provider tariff contract and payment data quality across markets and platforms.

• Implement appropriate model governance human oversight testing monitoring and explainability for AI-enabled decision support tools.

• Leverage internal and external intelligence sources to identify emerging fraud schemes market-specific risks and new control opportunities.

Governance Compliance & Quality Assurance

• Establish an effective anti-fraud and payment integrity governance framework including policies procedures controls evidence requirements and oversight forums.

• Ensure investigations audits data usage recoveries and external disclosures comply with applicable legal regulatory privacy and records-management requirements.

• Implement quality assurance peer review case sampling and audit-readiness practices across operational and investigative activities.

• Maintain strong controls around conflicts of interest confidentiality access management and segregation of duties.

• Provide timely reporting of material risks control weaknesses trends and remediation plans to senior leadership and governance bodies.

Leadership Partnerships & Commercial Enablement

• Lead develop and inspire a global multidisciplinary team spanning clinical coding audit analytics investigations operations and recovery expertise.

• Foster a high-performance culture focused on integrity accountability innovation collaboration and measurable outcomes.

• Build strong relationships with regional business leaders TPAs vendors providers Cigna Links and enterprise functions.

• Translate Payment Integrity and Investigations capabilities into compelling client-facing value propositions supporting RFPs renewals and retention efforts.

• Represent the function with executive leadership clients providers auditors regulators and external partners as required.

Requirements & Qualifications

• 15 years of progressive experience in healthcare payment integrity claims special investigations fraud risk clinical audit healthcare finance or related operations including significant leadership responsibility.

• Proven success leading complex multidisciplinary teams and delivering measurable payment prevention savings recovery quality and operational outcomes.

• Strong knowledge of healthcare claims reimbursement coding provider billing clinical review investigative methods fraud waste and abuse risks and recovery practices.

• Demonstrated ability to design and implement operating models governance frameworks controls analytics and technology-enabled transformation across multiple markets or business lines.

• Sound understanding of compliance privacy evidence handling regulatory engagement and legal considerations relevant to investigations and payment recovery.

• Excellent analytical judgement executive communication and stakeholder management skills.

• Proven ability to influence senior leaders and drive change across matrixed international organizations.

• Bachelors degree in Healthcare Administration Business Finance Clinical Sciences Data Analytics Law Criminal or Forensic Justice or a related field required.

• Advanced degree and/or relevant professional certification preferred.

• International experience and willingness to travel as required.

• Additional language capabilities are an advantage.

What We Offer

This role offers a rare opportunity to build lead and transform a critical capability within Cigna International Health.

You will have the platform to:

• Set the strategic direction for Payment Integrity and Investigations across international markets.

• Deliver measurable impact on healthcare affordability financial integrity and customer trust.

• Lead enterprise-wide transformation through data analytics AI and operational innovation.

• Influence senior leadership decision-making and shape long-term business strategy.

• Build a lasting legacy by developing a modern scalable and market-leading Payment Integrity function.

• Collaborate with talented colleagues across clinical claims provider finance compliance and technology disciplines globally.

• Be rewarded with a highly competitive compensation package and the opportunity to grow your career within a global healthcare leader.

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.