The Investigator role is responsible for the development, investigation, and presentation of complex fraud and/or abuse cases. Using analytical skills, in-depth drug and medical expertise, and audit tools, independently develop and execute investigation plans including the scope of procedures necessary to address risks in order to formalize sound recommendations for the investigation. A substantiated case, subject to certain criteria, will result in an in-depth referral to commercial and government clients.
Key Responsibilities:
• Analyze information gathered by investigation and report findings and prepare written summary/recommendations
• Lead virtual interviews of member/providers and pharmacies as necessary to obtain necessary information regarding the investigation
• Prepare reports to expedite tracking and reporting of investigations
• Prepare evidence package referrals to internal and external parties including; contract holders, law enforcement agencies/medical boards
Minimum Requirements:
• Clear and concise verbal and written communication skills
• Strong computer skills are required – Excel, Access and Word
• Bachelor’s Degree and/or pharmacy benefit management experience in lieu of degree
* 1+ years Fraud or Pharmacy experience
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.
About The Cigna Group
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.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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What We Do
At Cigna, we're more than a health insurance company. We are your partner in total health and wellness. And we’re here for you 24/7 – caring for your body and mind.
As a global health service company, Cigna's mission is to improve the health, well-being, and peace of mind of those we serve by making health care simple, affordable, and predictable.
Our values are the core of our culture. Our values guide how all 74,000 of us around the world work together, serve our customers, patients, clients, communities, and deliver on our mission.
