[Hiring] Healthcare Fraud Investigator - Case Development @Cigna Healthcare
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Role Description
Join a specialized Special Investigations (SIU) referral and case enhancement team focused on identifying and mitigating healthcare fraud. In this role, you’ll use your investigative experience and data‑driven insights to assess suspected fraud referrals, uncover high‑risk billing patterns, and guide meaningful investigations that protect patients and reduce financial risk for clients and customers.
• Independently research, analyze, and assess suspected healthcare fraud referrals using investigative techniques and data analysis.
• Identify high‑risk billing behaviors, fraud trends, and potential overpayments through detailed data review.
• Evaluate referrals submitted to SIU and determine whether allegations warrant full investigation.
• Deliver clear, well‑structured case assessments with actionable investigative recommendations.
• Partner closely with investigators and field staff to develop leads and refine investigative strategies.
• Use technology and analytics to support complex investigations and adapt investigative direction as new information emerges.
• Monitor industry alerts, regulatory updates, and fraud bulletins to assess potential exposure.
• Handle sensitive and confidential information with integrity and professionalism.
Qualifications
• 3+ years of experience in healthcare insurance investigation, audit or relevant experience
• Strong analytical, research, and problem‑solving skills
• Clear and concise written and verbal communication skills
• Proficiency with Microsoft Excel and Word
Requirements
• Bachelor’s degree in Criminal Justice or related field (preferred)
• AHFI and/or CFE certification (preferred)
• CPT and ICD‑10 coding knowledge (preferred)
• Experience working with data analytics tools and investigative databases (preferred)
• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Benefits
• Annual salary of 68,300 - 113,900 USD / yearly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
• Comprehensive range of benefits, with a focus on supporting your whole health.
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one of employment.
• 401(k), company paid life insurance, tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
Company Description
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Apply Now
Apply Now
Role Description
Join a specialized Special Investigations (SIU) referral and case enhancement team focused on identifying and mitigating healthcare fraud. In this role, you’ll use your investigative experience and data‑driven insights to assess suspected fraud referrals, uncover high‑risk billing patterns, and guide meaningful investigations that protect patients and reduce financial risk for clients and customers.
• Independently research, analyze, and assess suspected healthcare fraud referrals using investigative techniques and data analysis.
• Identify high‑risk billing behaviors, fraud trends, and potential overpayments through detailed data review.
• Evaluate referrals submitted to SIU and determine whether allegations warrant full investigation.
• Deliver clear, well‑structured case assessments with actionable investigative recommendations.
• Partner closely with investigators and field staff to develop leads and refine investigative strategies.
• Use technology and analytics to support complex investigations and adapt investigative direction as new information emerges.
• Monitor industry alerts, regulatory updates, and fraud bulletins to assess potential exposure.
• Handle sensitive and confidential information with integrity and professionalism.
Qualifications
• 3+ years of experience in healthcare insurance investigation, audit or relevant experience
• Strong analytical, research, and problem‑solving skills
• Clear and concise written and verbal communication skills
• Proficiency with Microsoft Excel and Word
Requirements
• Bachelor’s degree in Criminal Justice or related field (preferred)
• AHFI and/or CFE certification (preferred)
• CPT and ICD‑10 coding knowledge (preferred)
• Experience working with data analytics tools and investigative databases (preferred)
• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Benefits
• Annual salary of 68,300 - 113,900 USD / yearly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
• Comprehensive range of benefits, with a focus on supporting your whole health.
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one of employment.
• 401(k), company paid life insurance, tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
Company Description
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Apply Now
Apply Now