Healthcare Fraud Investigator (Remote)

• Conduct and support investigations and audits involving suspected healthcare fraud and potentially fraudulent claim activity.
• Analyze claims, investigative findings, audit results, and other relevant information to identify patterns, discrepancies, and potential fraud.
• Prepare clear written investigative summaries, findings, and recommendations.
• Develop evidence packages for referral to third parties, including contract holders, state insurance fraud bureaus, and law enforcement agencies.
• Lead on-site inspections and conduct patient and provider interviews, as needed.
• Respond to subpoenas and information requests from law enforcement agencies and state Departments of Insurance.
• Represent the company as a witness in judicial proceedings, when appropriate.
• Support special projects requiring expertise in fraud detection, healthcare investigations, claims auditing, and other SIU-related activities.
• Prepare reports and documentation to support effective tracking and reporting of investigations.

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• Strong investigative and analytical skills with the ability to evaluate information and clearly document findings.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Excel, Access, and Word.

• Bachelor's degree in Criminal Justice or a related field.

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credential.

• Experience working with healthcare claims, provider investigations, fraud detection, or Special Investigations Units.

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.

For this position, we anticipate offering an annual salary of 68,300 - 113,900 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here .

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 need a reasonable accommodation to complete the online application process, please email