Global Director of Payment Integrity & Investigations

About the role

Cigna Healthcare is looking for a leader to build and advance its Payment Integrity and Investigations capability within Cigna International Health. Reporting to senior leadership, the Director defines the strategy, operating model and roadmap for the function, which protects healthcare affordability, strengthens payment accuracy and prevents fraud, waste and abuse across international markets.

Key responsibilities

• Own the international Payment Integrity and Investigations strategy and operating model, from pre-payment controls and post-payment review to analytics, investigations, clinical and coding audit, recovery and root-cause remediation.
• Lead pre-payment prevention (edits, clinical rules, coding validations, duplicate-payment controls) and post-payment analytics, audits and claim reviews.
• Lead the Special Investigations capability for suspected fraud, waste and abuse, with risk-based case intake, triage and closure standards, and partner with Compliance, Legal, Privacy, Security and HR on sensitive cases.
• Own the financial and operational performance of the function, including prevention, cost avoidance, savings, recoveries, productivity, quality, cycle times and ROI, and build a recovery strategy across providers, members, vendors and third parties.
• Define the data and analytics strategy, sponsor advanced analytics, machine learning, AI and automation, and work with Data, Technology and Medical Economics to improve data quality.
• Set up an anti-fraud governance framework, ensure compliance with legal, regulatory and privacy requirements, and run quality assurance, peer review and audit readiness.
• Lead and develop a global multidisciplinary team, build relationships with regional business leaders, TPAs, providers and vendors, and turn the function's capabilities into client-facing value propositions for RFPs, renewals and retention.

Required profile

• 15+ years of progressive experience in healthcare payment integrity, claims, special investigations, fraud risk, clinical audit, healthcare finance or related operations, with significant leadership responsibility.
• Proven track record leading complex, multidisciplinary teams and delivering measurable payment prevention, savings, recovery, quality and operational results.
• Bachelor's degree in Healthcare Administration, Business, Finance, Clinical Sciences, Data Analytics, Law, Criminal or Forensic Justice or a related field; advanced degree or professional certification preferred.
• International experience and willingness to travel as required; additional languages are an advantage.

Required skills

• Strong knowledge of healthcare claims, reimbursement, coding, provider billing, clinical review, investigative methods and recovery practices.
• Ability to design operating models, governance frameworks, controls and analytics-driven transformation across multiple markets.
• Excellent analytical judgement, executive communication and stakeholder management, with the ability to influence senior leaders in matrixed international organisations.