Quality Review and Audit Analyst - Payment Integrity at Cigna

Your responsibilities will include:

• Identifying and preventing fraudulent, wasteful and abusive expenses from around the globe
• Perform a variety of prepay focused cost avoidance activities including:
• Identifying suspicious activity and submission to the designated FWA and SIU team for investigation
• Identifying internal operational errors to prevent incorrect payment being made
• Electronic outreaches to providers requesting documents and confirming information
• Occasional telephonic outreach to providers in local region to negotiate savings
• Verification of charges and services
• Partner with other areas within Payment Integrity to share best practices
• Analyze data on prior payments to identify additional opportunities
• Participate in projects to improve business processes
• Working collaboratively in a team environment to efficiently utilize each individual’s strengths
• Working closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers
• Providing feedback to other departments in order to put in place safeguards to prevent further risk exposure

Qualifications

• Demonstrated strong organization skills
• Strong attention to detail
• Ability to quickly learn new and complex tasks and concepts
• Competent in processing or investigating claims on either Mainframe, Diamond or GlobalCare claim platforms
• Fluency in foreign languages in addition to fluent English is a strong plus
• Data analysis and reporting skills preferred
• Inquisitive nature capable of thinking critically and challenging assumptions
• Demonstrated follow through on complex problems and tasks
• Comfortable working independently and with a team
• Ability to balance multiple priorities at once and deliver on tight timelines
• Ability to stay up to date on operations workflows
• Ability to develop and effectively communicate presentations and training materials
• Strong written and verbal communication skills
• Patience and creativity amongst your strong points
• Proficiency with Microsoft Excel needed. Word, PowerPoint, Outlook,  and SharePoint preferred
• Experience processing international claims preferred
• Comfort with telephonic outreaches to global entities preferred

Competencies

• Learning and applying quickly
• Organizing
• Priority Setting
• Problem Solving
• Interpersonal Savvy