Job Description
POSITION SUMMARY Join our Special Investigations Unit as a Fraud Investigator, supporting our US Commercial Healthcare Business, r esponsible for conducting and supporting audits and investigations of potentially fraudulent claim activity by providers. You will bring complex investigative and analytic skills that include planning, developing and implementing investigative processes and procedures. You will make recommendations for potential corrective actions that include prosecution, recovery and/or litigation based on investigative findings.
ESSENTIAL FUNCTIONS - Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations.
- Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies.
- Lead on-site inspections and patient/provider interviews as necessary.
- Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance. May represent company as a witness in judicial proceedings when appropriate.
- Perform special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations.
- Prepare reports to expedite tracking and reporting of investigations.
QUALIFICATIONS - 3+ years' experience in health insurance investigation/audit.
- Bachelor's Degree in Criminal Justice or related field strongly preferred.
- Clear and concise verbal and written communication skills.
- Strong computer skills are required - Excel, Access and Word.
- Accredited Health Care Fraud Investigator (AHFI) certification and Certified Fraud Examiner (CFE) preferred.
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 64,700 - 107,900 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.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, 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, visit Life at Cigna Group .
About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're 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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.
Job Tags
Holiday work, Permanent employment, Contract work, Local area, Work from home,