Position: Quality Review & Audit Analyst –Payment Integrity
This role is responsible for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring within a dedicated region. 

Responsibilities:

• Investigate potential instances of fraud, waste or abuse (FWA) across all Cigna’s International Markets books of business (excluding IO) for claims incurred in a dedicated region.
• Seek recovery of FWA payments from claim submissions.
• Ensure PI savings are tracked and reported accurately.
• Perform data-mining to reveal FWA trends and patterns.
• Collaborate with the Special Investigation Unit on Fraud cases.

Requirements:

• Minimum of 2 years of health insurance or health care provider experience.
• Knowledge of Globalcare, Actisure and/or Diamond essential.
• Knowledge of claims coding, regulatory rules and medical policy.
• Medical/ paramedical qualification is a definite plus.
• Experience with data analytics