Healthcare Fraud Investigator-Remote at The Cigna Group

United States

$68.3k - $113.9k

The job profile for this position is Fraud Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Healthcare Fraud Investigator: Make an impact protecting customers, data, and healthcare integrity. We’re looking for a skilled and motivated Healthcare Fraud Investigator to handle complex healthcare fraud matters that impact our customers and the organization. In this role, you’ll take ownership of investigations from start to finish—using sound judgment, analytic thinking, and collaboration to bring cases to resolution. This is an opportunity for investigators who enjoy digging into details, following the data, and working on high‑value cases that truly matter. What You’ll Do Lead in‑depth investigations into suspected or confirmed healthcare fraud, using a thoughtful and independent investigative approach. Gather, analyze, and synthesize information from a variety of sources, including claims data, records, interviews, and internal partners. Manage complex, high‑dollar investigations with a high degree of autonomy. Prepare clear, well‑documented investigative reports and evidence packages to support case resolution, recovery efforts, or external referrals. Coordinate with internal stakeholders and, when appropriate, local, state, or federal agencies to support investigations. Respond to subpoenas or regulatory inquiries and provide testimony when required, in partnership with legal and compliance teams. Support special projects related to fraud detection, auditing, and continuous improvement of investigative practices. Protect sensitive customer and company information, including PHI, while maintaining strict confidentiality standards. What You’ll Bring Bachelor’s degree in Criminal Justice or 7+ years of investigative claims experience 3+ years of healthcare fraud investigation, SIU, audit, payment integrity, or related experience. Proven ability to manage complex investigations independently and bring them to resolution. Strong analytical and computer skills, with proficiency in Microsoft Excel, Word, and similar tools. Excellent written and verbal communication skills, including the ability to present findings clearly and professionally. Comfort working with sensitive, confidential information and exercising sound judgment. Ability to adapt to changing priorities and work effectively in a fast‑paced environment. 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 and paid holidays. For more details on our employee benefits programs, click here. 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. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.