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.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 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 referral to 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 • Cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload for home-based work • 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)

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • 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 • Tobacco-free policy