Healthcare Fraud Investigator

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $68.3k - $113.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Conduct and support investigations and audits involving suspected healthcare fraud and potentially fraudulent claim activity • Analyze claims, investigative findings, audit results, and other relevant information to identify patterns, discrepancies, and potential fraud • Prepare written investigative summaries, findings, and recommendations • Develop evidence packages for contract holders, state insurance fraud bureaus, and law enforcement agencies • Lead on-site inspections and conduct patient and provider interviews as needed • Respond to subpoenas and information requests from law enforcement agencies and state Departments of Insurance • Represent the company as a witness in judicial proceedings when appropriate • Support special projects involving fraud detection, healthcare investigations, claims auditing, and SIU activities • Prepare reports and documentation to support tracking and reporting of investigations

🎯 Requirements

• 3+ years of experience in health insurance investigations and/or auditing • Strong investigative and analytical skills • Ability to evaluate information and clearly document findings • Excellent verbal and written communication skills • Proficiency with Microsoft Excel, Access, and Word • Bachelor’s degree in Criminal Justice or a related field (preferred) • Accredited Health Care Fraud Investigator (AHFI) certification or Certified Fraud Examiner (CFE) credential (preferred) • Experience with healthcare claims, provider investigations, fraud detection, or Special Investigations Units (preferred) • Role supports the U.S. Commercial Healthcare business

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work from home, subject to cable broadband or fiber optic internet service of at least 10Mbps download/5Mbps upload