Bilingual Junior Healthcare Fraud Investigator-Miami Work at Home

Cigna Healthcare • Miami, FL

13d • Remote

About The Position

This is an early-career opportunity for a recent college graduate with a Bachelor's degree in Criminal Justice to launch a career as a Healthcare Fraud Investigator. 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 utilize investigative and analytics skills, including planning, developing, and implementing investigative processes and procedures, and making recommendations for corrective actions such as prosecution, recovery, and/or litigation based on investigative findings.

Requirements

• Located in South Florida (Miami, homestead) and West Palm Beach area to support site visits
• Bilingual Spanish
• A bachelor’s degree in a Criminal Justice, or related field
• 1+ years professional work experience, preferably with health insurance investigations/audit
• 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
• If 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.

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