Fraud Senior Supervisor in Glasgow

About Cigna Healthcare, a division of The Cigna Group, is a global health services company dedicated to improving the health, wellbeing, and peace of mind of those we serve. Operating in over 30 countries, Cigna supports more than 190 million customer relationships worldwide through medical, dental, behavioral health, pharmacy, and vision care solutions.

Role Summary:

As a Fraud Senior Supervisor within the Member Investigation Unit you will be directly supporting Cigna’s affordability commitment within Cigna International's business and have specific responsibility for the quality and effectiveness of investigations into suspected member behaviours. This role is responsible for managing a team accountable for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring. This role will partner with internal stakeholders and specifically Client Management Teams to demonstrate good practice anti-fraud services, compliance with global regulatory and legislative requirements and will maintain integrity of all investigative data and reports.

Responsibilities:

• Lead the Member Investigation Team who are responsible for identifying and preventing fraudulent, wasteful and abusive expenses within Cigna’s International Business Market ensuring team targets and KPIs are met.
• Work closely with PI FWA senior management to understand strategy and is responsible for executing departmental plans and priorities.
• Represent the Payment Integrity function when engaging with external clients and reporting to and informing clients of their fraud risks.
• Accountable for managing internal stakeholder relationships.
• Coach, support and provide appropriate case guidance, to Investigators ensuring compliance with investigation standard operating models.
• Ensure department KPIs are met through effective monitoring and reporting mechanisms; ensure PI savings are tracked and reported accurately.
• Execute strategic initiatives, plans, and goals in alignment with department KPIs and financial targets.
• Effectively use business intelligence and data analytics to monitor PI FWA regional claim patterns and identify opportunities for PI intervention.
• Ensure Payment Integrity processes are in compliance with legal, regulatory and contractual requirements.
• Act with urgency when there is an elevated risk of fraud against Cigna and its customers and clients.
• Ensure investigative findings are documented and that all communications with clients are fact based and professional.
• Assess work demand against capacity to ensure optimum claim referrals across all referral routes; create solutions, drive execution and ensure timeliness and accuracy of PI claims review process, loss prevention and recovery activity.
• Instil work culture of continuous process improvement, innovation, and quality.
• Oversee departmental personnel matters; evaluating staff performance and conducting performance appraisals for all direct reports.
• Ensure adherence to company practices and procedures.
• Recommend changes in policy and procedures in order to mitigate risk and participate in projects to improve business protocols.
• Provide input into workforce planning and recruitment activities and address resource and operational challenges.
• Work closely with other departments to ensure Payment Integrity activities do not have an unnecessary negative impact on our customers.

Skills and Requirements:

• Experience of leading operational teams.
• An accredited counter fraud qualification.
• Minimum of 5 years of health insurance or international health care provider experience.
• Experience of operational risk management, including internal and external risk and compliance reporting.
• Knowledge of claims coding, regulatory rules and medical policy.
• Medical/paramedical qualification is a definite plus.
• Customer Focus – dedicated to meeting the expectations and requirements of internal and external customers, excellent at building effective relationships and gaining trust and respect.
• Passive knowledge of medical terminology and treatment modalities.
• Critical mind-set with ability to identify cost containment opportunities.
• Strong reporting and analytical skills with ability to create and improve reporting packs and methodologies with some support.
• An experience with data analytics tool(s) is a strong asset.
• Excellent verbal and written communication, interpersonal and negotiation 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.

What We Offer:

• The opportunity to work in a global, diverse and collaborative environment.
• Exposure to cross-functional teams and strategic projects.
• A culture that supports learning, development and internal career growth.
• A role with real impact on business performance and healthcare affordability.
• A supportive and inclusive workplace that values innovation and continuous improvement.
• A competitive benefits package, including a range of social benefits (location dependent).
• A hybrid working model and flexible working hours to support work-life balance.

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.