Cigna Fraud Specialist in Bloomfield, Connecticut
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 and restitution of high dollar amounts. Determines and acquires information pertinent to and impacting each situation investigated. Prepares reports to expedite tracking and reporting of investigations.
Prepares evidence packages for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies. Interfaces and coordinates investigations with appropriate State and Federal law enforcement agencies.
Responds to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance.
May represent company as a witness in judicial proceedings when appropriate.
Performs special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations. Works independently while at times receiving minimal direction and guidance.
- Through interviews, analysis, and investigation, resolves 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.
- This position requires significant contact with other business areas and outside agencies, such as Law Enforcement, Attorneys, and Departments of Insurance.
- Bachelor’s Degree in Criminal Justice or related field strongly preferred
- Minimum 3 years’ experience in health insurance investigation/audit strongly preferred
- Related experience in health insurance investigations preferred
- Technically strong
- Experience with Microsoft products strongly preferred (Excel, Access, Word)
- Strong communication skills, both written and oral, are required
- Must be able to adapt to changing priorities
Primary Location: Bloomfield-Connecticut
Other Locations: United States-Arizona-Chandler, United States-Pennsylvania-Philadelphia
Work Locations: 900 Cottage Grove Road Wilde Bloomfield 06152
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Travel: Yes, 25 % of the Time
Job Posting: Mar 13, 2018, 10:31:39 AM
Cigna is an equal opportunity employer, which means we offer equal treatment to all applicants. Cigna does not discriminate, either directly or indirectly, on the grounds of race, color, sex, gender identity, sexual orientation, nationality, national origin, ethnic origin, religion, beliefs or creed, age, disability, marital status, veteran status or genetic information in any area of recruitment. In some countries we ask for information on the ethnic origin, gender and disability of our applicants for the purpose of monitoring equal opportunity. If you have a disability and would like to indicate as part of your application any relevant effects of your disability and any adjustment which you consider should reasonably be made to the process to assist your application, please do so in the relevant field during the application process.