Fraud Specialist- Internal Investigations

ROLE SUMMARY

Performs specified investigative steps related to investigation of known or suspected fraud perpetrated against the company or customers.

Utilizing independent judgment and discretion, plans and initiates the appropriate course of action for the purpose of resolution of employee fraud.

Determines and acquires information pertinent to and impacting each situation investigated.

Prepares reports to expedite tracking and reporting of investigations.

Responds to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance.

Performs special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Internal Investigations.

Works independently while at times receiving minimal direction and guidance.

Responsible for investigating allegations related to employee fraud, waste, abuse and other violations of Cigna’s Code of Conduct in accordance with established policies and procedures.

Conducts investigations, reviews, and audits and makes recommendations for correcting control weaknesses to prevent future fraud occurrences.

Responsible for thoroughly documenting the results of investigations in accordance with established policies and procedures.

Ensures documented investigative findings are fact based.

Coordinates activities with Cigna business management to identify and report employee fraud schemes as well as establishing means to prevent further losses due to these schemes.

Responsible for supporting fraud managers in responding to inquiries related to Cigna’s internal fraud program from external parties, including client, regulatory and other fraud agencies, as necessary.

Acts with urgency when there is an elevated risk of fraud against Cigna and its customers and clients.

Identify automated monitoring/analytics opportunities for internal fraud schemes.

Ensures investigative path is in line with documented best practices and reaches a timely resolution or closure.

Conducts investigations in compliance with state and federal regulations and maintains integrity of all Internal Investigations data and reports.

Contribute to a continuous improvement approach within the Team.

Contribute to development and maintenance of process, procedure and departmental documentation.

Maintains a customer-centric focus that governs decision making by creating transparency and enhancing communication.

RESPONSIBILITIES

As a member of the internal investigations team, this individual will be responsible for the prompt handling of all assigned allegations.

Act with urgency when there is an elevated risk of internal fraud against Cigna.

Ensure communications with internal partners are fact based and professional.

Ensures documented investigative findings are fact based.

Ensures investigation process is in line with documented policies and procedures.

Conducts investigations in compliance with applicable regulations and maintains integrity of all Internal Investigations data and reports.

Through interviews, analysis, and investigation, resolve allegations or suspicions of fraud against our customers and company.

Must comply with reporting requirements, subpoenas, and requests for investigative assistance, while, at the same time, protecting our customers’ PHI.

Qualifications

Bachelor’s Degree in Criminal Justice or related field strongly preferred

Related experience in health insurance investigations or internal investigations strongly preferred

Computer skills are required

Experience with Microsoft products required (Excel, Access, Word, PowerPoint)

Strong communication skills, both written and oral, are required

Strong research and analytical skills required

Must be able to adapt to changing priorities

Minimum 3 years’ experience in health insurance investigation/audit strongly preferred

Certified Fraud Examiner, IIA certification and/or CPA preferred.

US

Candidates Only

: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at

SeeYourself@cigna.com

.

Primary Location

:

United States-Connecticut-Bloomfield

Other Locations

:

United States-Pennsylvania-Philadelphia

Work Locations

:

CT 900 Cottage Grove Road

900 Cottage Grove Road Wilde

Bloomfield

06152

Job

:

Finance–Audit

Work at home opportunity (External)

:

No

Schedule

:

Full-time

Shift

:

Day Job

Employee Status

:

Regular

Job Type

:

Standard

Job Level

:

Individual Contributor

Travel

:

Yes, 25 % of the Time

Job Posting

:

May 30, 2017, 11:00:31 AM