International Claims Quality Assurance Expert

2 months ago

Greenock, Inverclyde, United Kingdom The Cigna Group Full time

Job Summary

We are seeking a highly skilled and detail-oriented Payment Integrity Quality Review and Audit Associate Analyst to join our team at The Cigna Group. As a key member of our Payment Integrity team, you will play a critical role in supporting our affordability commitment within Cigna International's business.

Key Responsibilities

  • Identify and prevent fraudulent, wasteful, and abusive expenses from around the globe through a variety of prepay focused cost avoidance activities.
  • Perform a range of tasks, including:
    • Identifying suspicious activity and submitting it to the designated FWA and SIU team for investigation.
    • Identifying internal operational errors to prevent incorrect payments.
    • Electronic outreach to providers requesting documents and confirming information.
    • Occasional telephonic outreach to providers in local regions to negotiate savings.
    • Verification of charges and services.
    • Partnering with other areas within Payment Integrity to share best practices.
    • Analyzing data on prior payments to identify additional opportunities.
    • Participating in projects to improve business processes.
  • Work collaboratively in a team environment to efficiently utilize each individual's strengths.
  • Work closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers.
  • Provide feedback to other departments to put in place safeguards to prevent further risk exposure.

Requirements

  • Demonstrated strong organizational skills.
  • Strong attention to detail.
  • Ability to quickly learn new and complex tasks and concepts.
  • Competence in processing or investigating claims on either Mainframe, Diamond, or GlobalCare claim platforms.
  • Fluency in foreign languages in addition to fluent English is a strong plus.
  • Data analysis and reporting skills preferred.
  • Inquisitive nature capable of thinking critically and challenging assumptions.
  • Demonstrated follow-through on complex problems and tasks.
  • Comfortable working independently and with a team.
  • Ability to balance multiple priorities at once and deliver on tight timelines.
  • Ability to stay up to date on operations workflows.
  • Ability to develop and effectively communicate presentations and training materials.
  • Strong written and verbal communication skills.
  • Patience and creativity amongst your strong points.
  • Proficiency with Microsoft Excel needed. Word, PowerPoint, Outlook, and SharePoint preferred.
  • Experience processing international claims preferred.
  • Comfort with telephonic outreaches to global entities preferred.

Competencies

  • Learning and applying quickly.
  • Organizing.
  • Priority Setting.
  • Problem Solving.
  • Interpersonal Savvy.

About The Cigna Group

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

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