Medical Fraud Senior Analyst –Payment Integrity FWA Regional Team
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Key skills for this role
About the Role
Cigna is seeking a Medical Fraud Senior Analyst for its Payment Integrity FWA Regional Team in Riyadh. The role involves detecting and recovering fraud, waste, and abuse payments, performing data analysis, and collaborating with internal teams.
Key Skills for This Role
Responsibilities
- Identify and investigate potential instances of fraud, waste or abuse across Cigna's International Markets
- Perform prepay focused cost avoidance activities
- Seek recovery of FWA payments from claim submissions
- Research and analyze data to identify possible FWA cases
- Identify trends and patterns of insurance fraud through data analysis
- Work with investigative staff to develop leads
- Negotiate with out of network providers
- Provide investigation reports to internal and external stakeholders
Requirements
- Minimum 4 years of health insurance or healthcare provider experience
- Experience in investigation within payment integrity or similar discipline
- Knowledge of claims coding, local regulatory rules and medical policy
- Fluency in Arabic and English
- Strong attention to detail and organization skills
- Medical/paramedical qualification is a plus
Full Job Posting
Role Summary
- As Medical Fraud Senior Analyst within Payment Integrity FWA Team, you will support Cigna's affordability commitment within Cigna International's business within KSA.
- Responsible for detecting and recovering FWA payments for non network claims, creating solutions to prevent claims overpayment and future spend monitoring.
Responsibilities
- Identify and investigate potential instances of fraud, waste or abuse across all Cigna's International Markets.
- Perform a variety of prepay focused cost avoidance activities.
- Seek recovery of FWA payments from claim submissions.
- Independently research and analyze data using appropriate investigative techniques.
- Identify Trends and Patterns of Insurance Fraud through analysis of data.
- Work closely with investigative staff to further develop investigative leads.
- Ensure PI savings are tracked and reported accurately.
- Work in partnership to implement solutions to prevent claims overpayment.
- Negotiation with out of Network providers.
- Perform data mining to reveal FWA trends and patterns.
- Partner with Cigna TPAs on FWA investigations.
- Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
Skills and Requirements
- Experience of investigation within payment integrity or similar discipline.
- Minimum of 4 years of health insurance or health care provider experience.
- Knowledge of claims coding, local regulatory rules and medical policy.
- Medical/paramedical qualification is a definite plus.
- Critical mind set with ability to identify cost containment opportunities.
- Experience with data analytics.
- Strong organization skills and attention to detail.
- Ability to quickly learn new and complex tasks.
- Excellent verbal and written communication skills.
- Ability to balance multiple priorities and deliver on tight timelines.
- Flexibility to work with global teams and varying time zones.
- Experience in liaising with internal stakeholders.
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