01Overview
Role Description
The job profile for this position is Fraud Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. In this role, youll use your investigative experience and datadriven insights to assess suspected fraud referrals, uncover highrisk 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 highrisk 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, wellstructured 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
Required: 3+ years of experience in healthcare insurance investigation, audit or relevant experience.
Strong analytical, research, and problemsolving skills.
Clear and concise written and verbal communication skills.
Proficiency with Microsoft Excel and Word.
Preferred: Bachelors degree in Criminal Justice or related field.
AHFI and/or CFE certification.
CPT and ICD10 coding knowledge.
Experience working with data analytics tools and investigative databases.
Requirements
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, including medical, vision, dental, and well-being and behavioral health programs.
401(k) and company paid life insurance.
Tuition reimbursement.
A minimum of 18 days of paid time off per year and paid holidays.
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Company : The Cigna Group
Salary : Full-time
