[Hiring] Bilingual Junior Healthcare Fraud Investigator @Cigna Healthcare

Role Description

Are you ready to launch your Healthcare Fraud Investigator career and make a real difference? If you're a recent college graduate eager to take the first step in your professional journey, this early-career opportunity is designed for you. This is a fantastic opportunity for someone with a Bachelor's degree in Criminal Justice and is early in their career seeking to grow in a dynamic organization.

As a Junior Fraud Investigator for Cigna's Special Investigations Unit, you’ll support our US Commercial Healthcare Business in conducting and supporting audits and investigations of potentially fraudulent claim activity by providers. You will bring investigative and analytics skills that include:

• Planning, developing, and implementing investigative processes and procedures.
• Making recommendations for potential corrective actions that include prosecution, recovery, and/or litigation based on investigative findings.

What you’ll do:

• 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.
• Support 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.
• Prepare reports to expedite tracking and reporting of investigations.

Qualifications

• Located in South Florida (Miami, Homestead) and West Palm Beach area to support site visits.
• Bilingual Spanish.
• A bachelor’s degree in Criminal Justice or related field.
• 1+ years professional work experience, preferably with health insurance investigations/audit.
• Outstanding technical & analytical skills, with particular proficiency with Access, Excel, and Word.
• Excellent verbal and written communication skills, along with ability to effectively manage conflict.
• Keen ability to deal with ambiguity and leverage reasoning skills.
• Possession of a strong desire and demonstrated ability to lead.

Requirements

• 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.

Company Description

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.