Performs specified investigative steps related to investigation of known or suspected fraud perpetrated against the company or customers. Utilizing independent judgment and discretion, plans and initiates the appropriate course of action for the purpose of resolution and restitution of high dollar amounts. Determines and acquires information pertinent to and impacting each situation investigated. Prepares reports to expedite tracking and reporting of investigations. Prepares evidence packages for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies. Interfaces and coordinates investigations with appropriate State and Federal law enforcement agencies. Responds 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. Performs special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations. Works independently while at times receiving minimal direction and guidance.
Through interviews, analysis, and investigation, resolves allegations or suspicions of fraud against our customers and company. Must comply with reporting requirements, subpoenas, and requests for investigative assistance, while, at the same time, protecting our customers’ PHI. This position requires significant contact with other business areas and outside agencies, such as Law Enforcement, Attorneys, and Departments of Insurance.
Related experience in health insurance investigations preferred
Strong computer skills are required
Experience with Microsoft products strongly preferred (Excel, Access, Word)
Strong communication skills, both written and oral, are required
Must be able to adapt to changing priorities
Bachelor’s Degree in Criminal Justice or related field strongly or 7 years of investigative claims experience required
Minimum 3 years’ experience in health insurance investigation/audit strongly preferred
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
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 an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.