Healthcare Fraud Investigator - Remote

Join our Special Investigations Unit as a Fraud Investigator, supporting our US Commercial Healthcare Business, responsible for conducting and supporting audits and investigations of potentially fraudulent claim activity by providers. You will bring complex investigative and analytic skills that include planning, developing and implementing investigative processes and procedures. You will make recommendations for potential corrective actions that include prosecution, recovery and/or litigation based on investigative findings. 

Key Responsibilities:

• Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations

• Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies

• Lead on-site inspections and patient/provider interviews as necessary

• Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance. May represent company as a witness in judicial proceedings when appropriate

• Perform special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations

• Prepare reports to expedite tracking and reporting of investigations

Requirements:

• 3 years’ experience in health insurance investigation/audit preferred

• Bachelor’s Degree in Criminal Justice or related field preferred

• Clear and concise verbal and written communication skills

• Strong attention to detail, independent & critical thinking skills

• Strong computer skills are required – Excel and Word, Access a plus

• Accredited Health Care Fraud Investigator (AHFI) certification and Certified Fraud Examiner (CFE) 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 64,700 - 107,900 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 Life at Cigna Group.

About The Cigna Group

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