Fraud Analyst (Pre-Pay)

Responsibilities:

• Manages Team mailbox and responds or directs enquiries appropriately.
• Acts as initial review point for (possible) fraudulent claims.
• Identifying claims with potential waste and abuse
• Provides initial review and research to help determine if claims require further investigation to determine possible fraudulent activity.
• Contact providers requesting documents and confirming information.
• Uphold documentation and process standards
• Partner with cost containment teams in other geographies to share best practices.
• Participate in projects to improve business processes.
• Ensure team savings are tracked and reported accurately.
• Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
• Partner with Data Analytics team in building future FWA triggers automation.
• Support the production of investigation reports to internal and external stakeholders by compiling and storing evidence appropriately.

Skills and Requirements:

• You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best.
• Experience of fraud investigation strongly desired.
• Minimum of 2 years of health insurance or health care provider experience.
• Knowledge of claims coding, regulatory rules and medical policy.
• Medical/ paramedical qualification is a definite plus.
• Demonstrated strong organization skills.
• Strong attention to detail.
• Ability to quickly learn new and complex tasks and concepts.
• Critical mind-set with ability to identify cost containment opportunities.
• Excellent verbal and written communication skills.
• Ability to balance multiple priorities at once and deliver on tight timelines.
• Flexibility to work with global teams and varying time zones effectively.
• Confidence to deal with internal stakeholders and ability to work with a cross functional team.
• Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines.
• Fluency in foreign languages in addition to fluent English is a strong plus.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.