Payment Integrity Prepay Fraud Supervisor - Cigna Healthcare
Core
Lead a regional prepayment team to identify and prevent fraudulent, wasteful, and abusive expenses in Cigna's International Business Market, ensuring claims are not paid as received.
Role type
Senior IC payment integrity supervisor (health insurance)
Builds
Provider integrity targets and KPIs for international markets
Domain
Health insurance / International claims
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Team leadership, stakeholder management, claims investigation, policy recommendation, performance appraisal, process improvement, data analysis, Microsoft Excel proficiency
Preferred skills
Payment Integrity function experience, international claims processing, foreign language fluency, medical terminology knowledge, telephonic outreach
Technologies
GlobalCare, Actisure, Microsoft Excel, Word, PowerPoint, Outlook, SharePoint
Responsibilities
Lead regional prepayment team to identify claims with potential Fraud, Waste and Abuse savings; Execute departmental plans and priorities; Coach and support team members to monitor non-compliance; Ensure department KPIs are met through monitoring and reporting; Oversee personnel matters including performance evaluations; Verify services and charges and negotiate with providers; Recommend changes in policy and procedures to mitigate risk.
Seniority
Senior, hands-on IC with management responsibilities