Fraud Analyst (Pre-Pay) - Payment Integrity

About the role

Cigna Healthcare, a division of The Cigna Group, is hiring a Fraud Analyst (Pre-Pay) in its Payment Integrity Department in Madrid. This is a Band 2 Senior Contributor career-track role that supports Cigna's affordability commitment within Cigna International's business. The analyst identifies and prevents fraudulent, wasteful and abusive expenses worldwide and supports the Payment Integrity FWA Team with client reporting.

Key responsibilities

• Manage the team mailbox and respond to or direct enquiries appropriately.
• Act as the first point of review for possible fraudulent claims, identifying those with potential waste and abuse.
• Carry out initial review and research to decide whether claims need further investigation.
• Contact providers to request documents and confirm information.
• Uphold documentation and process standards.
• Share best practices with cost containment teams in other geographies and partner with FWA teams elsewhere on claiming schemes.
• Work with the Data Analytics team to build future FWA trigger automation.
• Track and report team savings accurately and compile evidence for investigation reports for internal and external stakeholders.

Required profile

• Experience of fraud investigation strongly desired; minimum of 2 years of health insurance or health care provider experience.
• Medical or paramedical qualification is a definite plus.
• Fluency in a foreign language in addition to English is a strong plus.
• Ability to work with global teams across time zones, handle multiple priorities and tight deadlines, and communicate clearly with internal stakeholders.

Required skills

• Competence in processing or investigating claims on Diamond.
• Knowledge of claims coding, regulatory rules and medical policy.
• Strong organisation, attention to detail and critical thinking to spot cost containment opportunities.