[Remote] Healthcare Fraud Investigator - Case Development- Remote
Note: The job is a remote job and is open to candidates in USA. Cigna Healthcare is dedicated to improving the health and vitality of those they serve, and they are seeking a Healthcare Fraud Investigator to join their Special Investigations team. In this role, you will use investigative techniques and data analysis to assess suspected healthcare fraud referrals, uncover billing patterns, and guide investigations that protect patients and reduce financial risk for clients.
Responsibilities
• Independently research, analyze, and assess suspected healthcare fraud referrals using investigative techniques and data analysis
• Identify high‑risk billing behaviors, fraud trends, and potential overpayments through detailed data review
• Evaluate referrals submitted to SIU and determine whether allegations warrant full investigation
• Deliver clear, well‑structured case assessments with actionable investigative recommendations
• Partner closely with investigators and field staff to develop leads and refine investigative strategies
• Use technology and analytics to support complex investigations and adapt investigative direction as new information emerges
• Monitor industry alerts, regulatory updates, and fraud bulletins to assess potential exposure
• Handle sensitive and confidential information with integrity and professionalism
Skills
• 3 + years of experience in healthcare insurance investigation, audit or relevant experience
• Strong analytical, research, and problem‑solving skills
• Clear and concise written and verbal communication skills
• Proficiency with Microsoft Excel and Word
• Bachelor's degree in Criminal Justice or related field
• AHFI and/or CFE certification
• CPT and ICD‑10 coding knowledge
• Experience working with data analytics tools and investigative databases
Benefits
• Medical
• Vision
• Dental
• Well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year
• Paid holidays
Company Overview
• We are a health benefits provider that advocates for better health through every stage of life. It was founded in 1982, and is headquartered in Bloomfield, CT, US, with a workforce of 10001+ employees. Its website is http://www.cigna.com.
Apply Now
Apply Now
Responsibilities
• Independently research, analyze, and assess suspected healthcare fraud referrals using investigative techniques and data analysis
• Identify high‑risk billing behaviors, fraud trends, and potential overpayments through detailed data review
• Evaluate referrals submitted to SIU and determine whether allegations warrant full investigation
• Deliver clear, well‑structured case assessments with actionable investigative recommendations
• Partner closely with investigators and field staff to develop leads and refine investigative strategies
• Use technology and analytics to support complex investigations and adapt investigative direction as new information emerges
• Monitor industry alerts, regulatory updates, and fraud bulletins to assess potential exposure
• Handle sensitive and confidential information with integrity and professionalism
Skills
• 3 + years of experience in healthcare insurance investigation, audit or relevant experience
• Strong analytical, research, and problem‑solving skills
• Clear and concise written and verbal communication skills
• Proficiency with Microsoft Excel and Word
• Bachelor's degree in Criminal Justice or related field
• AHFI and/or CFE certification
• CPT and ICD‑10 coding knowledge
• Experience working with data analytics tools and investigative databases
Benefits
• Medical
• Vision
• Dental
• Well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year
• Paid holidays
Company Overview
• We are a health benefits provider that advocates for better health through every stage of life. It was founded in 1982, and is headquartered in Bloomfield, CT, US, with a workforce of 10001+ employees. Its website is http://www.cigna.com.
Apply Now
Apply Now