Quality Review and Audit Analyst – Payment Integrity

Your responsibilities will include:

Identifying and preventing fraudulent, wasteful and abusive expenses from around the globe
Perform a variety of prepay focused cost avoidance activities including:
Identifying suspicious activity and submission to the designated FWA and SIU team for investigation
Identifying internal operational errors to prevent incorrect payment being made
Electronic outreaches to providers requesting documents and confirming information
Occasional telephonic outreach to providers in local region to negotiate savings
Verification of charges and services
Partner with other areas within Payment Integrity to share best practices
Analyze data on prior payments to identify additional opportunities
Participate in projects to improve business processes
Working collaboratively in a team environment to efficiently utilize each individual’s strengths
Working closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers
Providing feedback to other departments in order to put in place safeguards to prevent further risk exposure

Qualifications

Demonstrated strong organization skills
Strong attention to detail
Ability to quickly learn new and complex tasks and concepts
Competent 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

Apply via :

cigna.wd5.myworkdayjobs.com