Bilingual Junior Healthcare Fraud Investigator-Florida Work at Home

Cigna Healthcare • Sunrise, FL

5d • Remote

About The Position

This is an early-career opportunity for a Bilingual Spanish Junior Healthcare Fraud Investigator to launch their career and make a real difference. As a Junior Fraud Investigator for Cigna's Special Investigations Unit, you will support the US Commercial Healthcare Business in conducting and supporting audits and investigations of potentially fraudulent claim activity by providers. You will bring investigative and analytics skills that include planning, developing and implementing investigative processes and procedures, along with making recommendations for potential corrective actions that include prosecution, recovery and/or litigation based on investigative findings.

Requirements

• Bilingual Spanish and ability to pass oral and written assessments
• A bachelor’s degree in a Criminal Justice, or related field
• 1+ years professional work experience, preferably with health insurance investigations/audit
• Reside near South Florida (Miami, homestead) and West Palm Beach area for occasional site visits
• Outstanding technical & analytical skills, with particular proficiency with Access, Excel and Word
• Excellent verbal and written communication skills, along with ability to effectively manage conflict
• Keen ability to deal with ambiguity and leverage reasoning skills
• Possession of a strong desire and demonstrated ability to lead
• Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Responsibilities

• Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations
• Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies
• Support on-site inspections and patient/provider interviews as necessary
• Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance.
• May represent company as a witness in judicial proceedings when appropriate
• Prepare reports to expedite tracking and reporting of investigations

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level