Healthcare Fraud Investigator – Case Development- Remote in USA

Healthcare Fraud Investigator - Case Development- Remote - Cigna - USA - work from home job Company: Cigna Job description: Become a member of Special Investigations referral and case enhancement team that works closely with analysts, investigators, advanced IT specialists, and management. The primary responsibility of the position is to perform a comprehensive in depth review on suspected claims fraud referrals received from sources outside of SIU or identified proactively. Effectively integrates claims fraud investigation experience and industry knowledge with the use of data analytics. Responsible for efficiently and accurately assessing referrals submitted to the SIU for investigation to determine if there is merit in the allegation and a matter that should be addressed by SIU. Conducts a comprehensive review to identify highly suspect billing behaviors and trends, potential overpayments and formulates specific investigative next steps. The finished product should be packaged in a manner that allows the investigator to fully understand what actions should be taken to mitigate patient harm and financial risk to our clients, customers and Cigna. Responsibilities • Independently and proactively research and analyze data for insurance fraud while applying appropriate investigative techniques. • Identify trends and patterns of insurance fraud through analysis of data. • Receive investigative requests from field staff and promptly return a case assessment that is clearly articulated, with meaningful, actionable steps. Work closely with investigative staff to further develop investigative leads. • Attend industry and law enforcement meetings to actively participate in the development and sharing of information. • Use technology and analysis to drive the results of major case investigations. Monitor progress of the investigation. As new information surfaces, may redirect the course of the investigation. • Proactively monitor industry information bulletins to assess potential exposure to the company. • Handle personal and confidential information with a high degree of integrity. Qualifications • Minimum 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 • CPT and ICD10 coding knowledge strongly 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 63,700 - 106,100 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 . 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: [email protected] for support. Do not email [email protected] 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. Expected salary: $63700 - 106100 per year Location: USA Job date: Sat, 23 Sep 2023 04:30:13 GMT Apply for the job now! Apply tot his job