Quality Review and Audit Senior Analyst, Payment

1 day ago

Singapore Cigna Full time

Quality Review and Audit Senior Analyst - Payment Integrity FWA (Regional APAC Team)

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**Role Summary**:
As Quality Review and Audit Senior Analyst within Payment Integrity FWA Team you will be directly supporting Cigna’s affordability commitment within Cigna International's business. This role is responsible for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring within a dedicated region. He/She will work closely with other PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, Product and International Markets Special Investigation Unit (SIU).

**Responsibilities**:

- Identify and 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.
- Work in partnership to implement solutions and drive execution to prevent claims overpayment, unnecessary claim spend, and ensure timeliness and accuracy of PI claims review process.
- Negotiation with providers contracted by Cigna or out-of-Network providers.
- Perform data-mining to reveal FWA trends and patterns.
- Collaborate with the Special Investigation Unit on Fraud cases.
- Partner with Cigna TPAs on FWA investigations.
- Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
- Partner with Data Analytics team in building future FWA triggers automation.
- Provide investigation reports to internal and external stakeholders.

**Skills and Requirements**:
You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best.

Experience of investigation within payment integrity or similar discipline.

Minimum of 4 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.

Critical mind-set with ability to identify cost containment opportunities.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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