Job Summary:
This role will also oversee multiple investigations as it relates to pharmacy and patient outreach and must coordinate the successful transfer of essential case data between the partner and the SIU.
Essential Functions:
Directly interact with multiple levels within partner organization to coordinate Fraud Waste and Abuse activities. Interactions will include meetings with attendees including partner Senior Managers and Directors.
Coordinate multiple investigations to manage investigative outreach and communicate case details between external and internal investigators.
Facilitate triage and coordination of partner fraud tips and communicate the outcomes in an intelligent, professional, and informed manner.
Work with partner and SIU management to proactively seek out process improvement as the relationship matures and areas of opportunities are identified.
Understand back-end systems and reporting processes to troubleshoot gaps or issues.
QUALIFICATIONS
College degree in related field preferred or 3+ years of equivalent work experience
Relevant experience as a Fraud Investigator in healthcare
Certified Pharmacy Technician, Certified Fraud Examiner, or similar certification strongly desired.
Highly proficient in Microsoft Access & Excel, and data warehousing applications.
Excellent organizational and interpersonal skills, critical thinking and planning skills, verbal and written communication skills.
Ability to present to clients and internal stakeholders.
Ability to work well with senior management and high level external contacts, handle sensitive or confidential information is critical, work with minimum management oversight on multiple projects with competing priorities.
Ability to work a flexible schedule to accommodate project deadlines.
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
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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