Healthcare Fraud Investigator - Case Development- Remote

📋 Description

• • Embark on a critical mission within The Cigna Group's specialized Special Investigations Unit (SIU) referral and case enhancement team, where your expertise will be instrumental in identifying and mitigating healthcare fraud.
• • This role is designed for a proactive and analytical individual who thrives on uncovering complex schemes and protecting both patients and the financial integrity of our clients and customers.
• • You will be at the forefront of assessing suspected fraud referrals, employing a combination of seasoned investigative techniques and data-driven insights to discern high-risk billing patterns and guide the direction of meaningful investigations.
• • Your primary responsibility will involve independently researching, analyzing, and meticulously assessing suspected healthcare fraud referrals.
• • This assessment will leverage your strong analytical and problem-solving skills to identify potential fraudulent activities and financial discrepancies.
• • A key aspect of your role will be to pinpoint high-risk billing behaviors, emerging fraud trends, and potential overpayments through the detailed review of complex datasets.
• • You will critically evaluate referrals submitted to the SIU, making informed decisions on whether allegations warrant a full, in-depth investigation.
• • The ability to articulate your findings clearly and concisely is paramount, as you will be tasked with delivering well-structured case assessments that include actionable investigative recommendations.
• • Collaboration is key; you will partner closely with a team of experienced investigators and field staff, providing them with the insights needed to develop promising leads and refine their investigative strategies.
• • You will be expected to adeptly utilize technology and advanced analytics to support complex investigations, remaining agile and ready to adapt investigative direction as new information surfaces.
• • Staying ahead of emerging threats is crucial, requiring you to actively monitor industry alerts, regulatory updates, and fraud bulletins to proactively assess potential exposure to fraudulent activities.
• • Handling sensitive and confidential information with the utmost integrity and professionalism is a non-negotiable requirement of this position.
• • This role offers a unique opportunity to make a tangible impact by safeguarding the healthcare system from fraudulent practices, contributing directly to the company's mission of improving health and vitality.
• • You will be empowered to make critical decisions that shape the course of investigations, ensuring resources are allocated effectively and efficiently.
• • The remote nature of this position allows for flexibility while demanding a high degree of self-discipline and organizational skill to manage your workload effectively.
• • Your contributions will directly support the company's commitment to providing reliable and trustworthy healthcare services to its members.
• • You will be part of a dedicated team that values thoroughness, accuracy, and a commitment to ethical investigative practices.
• • The role requires a keen eye for detail and the ability to connect disparate pieces of information to form a comprehensive understanding of potential fraud schemes.
• • You will contribute to a culture of continuous improvement within the SIU by identifying opportunities to enhance investigative processes and analytical methodologies.
• • This position is ideal for an individual with a strong investigative background who is eager to apply their skills in a dynamic and impactful environment within the healthcare insurance sector.
• • Your work will directly contribute to reducing financial losses and ensuring the integrity of healthcare services for millions of individuals.
• • You will develop a deep understanding of healthcare billing practices, coding systems, and common fraud schemes, becoming a subject matter expert in the field.
• • The ability to work autonomously and manage multiple cases simultaneously, while maintaining high standards of quality and accuracy, will be essential for success in this role.
• • You will play a vital role in protecting The Cigna Group's reputation and its commitment to ethical business practices.
• • This is an opportunity to grow your career in a specialized area of investigation with a leading healthcare organization.