The job profile for this position is Fraud Analyst (Pre-Pay) , which is a Band 2 Senior Contributor Career Track Role.
Role Summary:
As Fraud Analyst (Pre-Pay) , within the Payment Integrity Fraud Investigation Unit, you will be directly supporting Cigna’s affordability commitment within Cigna International\'s bus iness. This role i s responsibl e for i dentifying and preven ting fra udulent, wasteful and abusive expenses from around the globe and supporting the Fraud Investigation Team with client reporting.
R esponsibilities :
Manages the Fraud Investigation Team mailbox and responds or directs enquiries appropriately .
Acts as initial review point for (possible) fraudulent claims.
Identifying internal operational errors to prevent incorrect payment being made .
Provides initial review and research to help determine if claims require further investigation to determine possible fraudulent activity.
Contact providers and members requesting documents and confirming information .
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 int ernal 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.
M inimum of 2 years of health insurance or health care provider experience .
Competent in processing or investigating claims on Mainframe .
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.
S trong organization skills with the a bility to juggle priorities and work under pressure to meet tight deadlines.
Fluency in foreign languages in addition to fluent English is a strong plus .
Work location: Hybrid model (work at home and in office).
About Cigna Healthcare
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.Fraud Analyst (Pre-Pay) – Fraud Investigation Unit
The job profile for this position is Fraud Analyst (Pre-Pay) , which is a Band 2 Senior Contributor Career Track Role.
Role Summary:
As Fraud Analyst (Pre-Pay) , within the Payment Integrity Fraud Investigation Unit, you will be directly supporting Cigna’s affordability commitment within Cigna International\'s bus iness. This role i s responsibl e for i dentifying and preven ting fra udulent, wasteful and abusive expenses from around the globe and supporting the Fraud Investigation Team with client reporting.
R esponsibilities :
Manages the Fraud Investigation Team mailbox and responds or directs enquiries appropriately .
Acts as initial review point for (possible) fraudulent claims.
Identifying internal operational errors to prevent incorrect payment being made .
Provides initial review and research to help determine if claims require further investigation to determine possible fraudulent activity.
Contact providers and members requesting documents and confirming information .
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 int ernal 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.
M inimum of 2 years of health insurance or health care provider experience .
Competent in processing or investigating claims on Mainframe .
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.
S trong organization skills with the a bility to juggle priorities and work under pressure to meet tight deadlines.
Fluency in foreign languages in addition to fluent English is a strong plus .
Work location: Hybrid model (work at home and in office).
About Cigna Healthcare
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.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: SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response.
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.
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Contact Details:
Cigna Health and Life Insurance Company Recruitment Team
StudySmarter Expert Advice🤫
We think this is how you could land Fraud Analyst in Greenock
✨Dive Into Industry Networking Events
Get your foot in the door by attending insurance industry events and conferences. Not only will you learn about the latest trends, but you'll also meet potential employers and industry peers. Check out local chapters of professional bodies like the Chartered Insurance Institute for valuable meetups.
✨Use LinkedIn to Your Advantage
Don’t underestimate the power of LinkedIn in the insurance world. Engage with industry content, join relevant groups, and connect with professionals at companies you admire (like Cigna Health and Life Insurance Company). A thoughtful message explaining your interest can really make a difference!
✨Look Out for Graduate Schemes
Many firms in insurance have structured graduate programmes. Keep an eye on application windows and utilise your university's career services for insider tips. These schemes are designed to develop talent and often lead to permanent roles after your initial training.
✨Leverage Your Current Connections
Got friends or family in the industry? Now’s the time to reach out! Personal referrals can give you a head start, so let them know you're on the lookout for full-time opportunities at places like Cigna Health and Life Insurance Company. Don’t shy away from asking for a coffee chat; you never know what doors it might open!
Some tips for your application 🫡
Highlight Your Analytical Skills:In insurance, we love a candidate who can crunch numbers and analyse data effectively. When crafting your CV, make sure to showcase any relevant coursework or experiences that highlight your analytical abilities, especially if you’ve tackled risk assessment or financial modelling.
Showcase Industry Knowledge:Don’t be shy about your knowledge of the insurance sector! We want to see that you've done your homework on current trends, regulations, and challenges in the industry. Mention any relevant projects or studies you’ve completed that demonstrate your understanding of the field in your cover letter.
Craft a Compelling Cover Letter:Your cover letter should tell us why you’re passionate about insurance. Share any personal experiences or what drew you into this profession. We’re looking for enthusiasm and a clear motivation for why you want to be part of our team at Cigna Health and Life Insurance Company.
Tailor Your CV for the Role:Don't just send a generic CV! Focus on tailoring it specifically for the insurance role at Cigna Health and Life Insurance Company. Highlight relevant skills such as risk management, customer service experience, or any certifications you've earned in the industry to make your application stand out.
How to prepare for a job interview at Cigna Health and Life Insurance Company
✨Know Your Numbers: Insurance Fundamentals
Brush up on your understanding of key insurance concepts, like underwriting principles and risk assessment. Expect the interviewer at Cigna Health and Life Insurance Company to throw some technical questions your way, so be ready to demonstrate your grasp of these essentials.
✨Showcase Your Analytical Side
In the insurance world, it's all about data. Prepare to discuss any analytical tools or methodologies you've used in past experiences. If you have a portfolio of projects where you've tackled complex data, bring that along to impress the team!
✨Prepare for Behavioural Questions
As a full-timer at Cigna Health and Life Insurance Company, they'll want to know how you handle real-life scenarios, not just theory. Think about challenges you've faced in teamwork or customer service, and how those experiences can relate to a career in insurance.
✨Know the Company Culture Inside Out
Understanding Cigna Health and Life Insurance Company's values and workplace culture is essential. Don’t just memorise their mission statement; think about how your personal values align with theirs. This will show your genuine interest in being part of their team long-term.
