Medical Fraud Senior Analyst –Payment Integrity FWA Regional Team

Position Overview

We are seeking a highly skilled and experienced Medical Fraud Senior Analyst to join our Payment Integrity Fraud, Waste, and Abuse (FWA) Regional Team based in Riyadh, Saudi Arabia. In this critical role, you will play a pivotal part in safeguarding Cigna’s financial and operational integrity by identifying, investigating, and mitigating fraudulent activities within the healthcare payment ecosystem. Your expertise will directly contribute to reducing financial losses, ensuring compliance with regulatory standards, and upholding the highest ethical standards in healthcare delivery.

Key Responsibilities

• Fraud Detection and Investigation: Lead the identification, analysis, and investigation of potential fraudulent, wasteful, or abusive activities in healthcare claims, provider billing, and member transactions. Utilize advanced analytical tools, data mining techniques, and industry best practices to uncover irregularities and suspicious patterns.
• Regional Collaboration: Work closely with cross-functional teams across the region, including legal, compliance, claims operations, and external partners, to share insights, coordinate investigations, and implement corrective measures. Foster a culture of collaboration to enhance the effectiveness of fraud prevention strategies.
• Data Analysis and Reporting: Develop and maintain robust reporting mechanisms to track fraud trends, quantify financial impacts, and measure the effectiveness of mitigation efforts. Prepare detailed reports for senior management, regulatory bodies, and stakeholders to support decision-making and compliance reporting.
• Policy and Procedure Development: Contribute to the enhancement of existing fraud detection policies, procedures, and controls. Stay abreast of evolving regulatory requirements and industry standards to ensure alignment with local and international compliance frameworks.
• Training and Awareness: Lead training sessions and awareness programs for internal teams and external partners to promote a proactive approach to fraud detection and prevention. Educate stakeholders on emerging fraud schemes, red flags, and best practices for maintaining compliance.
• Vendor and Partner Management: Collaborate with third-party vendors, auditors, and law enforcement agencies to conduct joint investigations, share intelligence, and implement preventive measures. Ensure seamless coordination to maximize the impact of fraud prevention initiatives.
• Risk Assessment and Mitigation: Conduct risk assessments to identify vulnerabilities within the payment integrity framework. Propose and implement strategic interventions to mitigate risks and enhance the resilience of Cigna’s operations against fraudulent activities.

Qualifications and Skills

• Education: Bachelor’s degree in Healthcare Administration, Finance, Accounting, Criminal Justice, or a related field. Advanced degrees or professional certifications (e.g., CFE, CPA, or CIA) are highly desirable.
• Experience: Minimum of 5 years of progressive experience in fraud investigation, healthcare claims analysis, payment integrity, or a related field. Prior experience in a senior analytical or leadership role within a healthcare or insurance environment is preferred.
• Technical Proficiency: Strong proficiency in data analysis tools (e.g., SQL, SAS, Tableau, or Power BI) and familiarity with healthcare billing systems (e.g., ICD-10, CPT, HCPCS). Experience with fraud detection software and AI-driven analytics is a plus.
• Analytical Skills: Exceptional analytical thinking, problem-solving abilities, and attention to detail. Ability to interpret complex data sets and derive actionable insights to drive fraud prevention strategies.
• Communication and Leadership: Excellent verbal and written communication skills, with the ability to articulate findings, recommendations, and compliance requirements to diverse audiences. Demonstrated leadership in driving cross-functional initiatives and fostering a culture of integrity.
• Regulatory Knowledge: In-depth understanding of healthcare regulations, including HIPAA, CMS guidelines, and local Saudi Arabian healthcare laws. Familiarity with anti-fraud statutes and enforcement trends is essential.
• Language Proficiency: Fluency in English; proficiency in Arabic is a strong advantage.

Why Join Cigna?

As a global leader in health services, Cigna is committed to transforming healthcare through innovation, integrity, and customer-centric solutions. Joining our Payment Integrity FWA Regional Team offers a unique opportunity to make a tangible impact on the integrity of healthcare systems while advancing your career in a dynamic and supportive environment. You will benefit from:

• Competitive compensation and comprehensive benefits packages.
• Professional development opportunities through training, certifications, and mentorship programs.
• Collaborative and inclusive work culture that values diversity and innovation.
• Access to cutting-edge technologies and resources to enhance your analytical capabilities.
• Opportunities to contribute to meaningful projects that shape the future of healthcare in the region.

If you are a results-driven professional with a passion for combating fraud and upholding ethical standards in healthcare, we invite you to apply and become a key player in our mission to deliver exceptional health services with integrity.