Fraud Analyst at Cigna Kenya
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Nairobi, Kenya
Job summary
Fraud Analyst at Cigna
About this role
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Role Summary
The Fraud Analyst (Pre-Pay) will work within the Payment Integrity Department, supporting Cigna International’s affordability objectives. The role focuses on detecting and preventing fraudulent, wasteful and abusive healthcare expenses across global markets while assisting the Payment Integrity FWA Team with client reporting.
Responsibilities
Manage the team mailbox by responding to enquiries or directing them to the appropriate teams.
Serve as the first point of review for claims that may involve fraudulent activity.
Identify claims that show possible signs of waste or abuse.
Conduct initial claim reviews and research to determine whether further investigation is necessary.
Contact healthcare providers to request supporting documents and verify information.
Maintain required documentation and follow established process standards.
Work with cost containment teams across different regions to exchange effective practices.
Take part in initiatives aimed at improving business processes.
Accurately track and report savings generated by the team.
Collaborate with Payment Integrity teams in other locations to share information on emerging FWA claim schemes.
Work with the Data Analytics team to develop future automated FWA detection triggers.
Assist with preparing investigation reports for internal and external stakeholders by properly compiling, organizing and storing supporting evidence.
Skills and Requirements
Ability to work effectively within a high-performing team where members are accountable for delivering strong results.
At least 2 years of experience in health insurance or healthcare provider environments, with fraud investigation experience strongly preferred.
Understanding of claims coding, regulatory requirements and medical policies.
A medical or paramedical qualification is an added advantage.
Strong organizational and planning abilities.
Excellent attention to detail.
Ability to understand and adapt quickly to new and complex tasks and concepts.
Strong analytical and critical-thinking skills, with the ability to recognize cost containment opportunities.
Excellent written and verbal communication skills.
Ability to manage several priorities simultaneously while meeting tight deadlines.
Comfortable working with global teams across different time zones.
Confidence when engaging internal stakeholders and working across different functions.
Ability to remain organized, manage competing priorities and perform effectively under pressure.
Fluency in additional foreign languages alongside fluent English is an added advantage.