Fraud Advisor - Hybrid

Cigna Healthcare•St. Louis, MO

20h•Hybrid

About The Position

The Fraud Advisor supports the identification, development, and resolution of fraud, waste, and abuse (FWA) investigations across the healthcare environment. This role applies investigative judgment, data analysis, and collaboration with cross-functional partners to assess risk, document findings, and support program integrity efforts. At The Cigna Group, the company is dedicated to improving the health and vitality of those they serve through their divisions Cigna Healthcare and Evernorth Health Services, committed to enhancing the lives of clients, customers and patients.

Requirements

Bachelor’s degree in Business, Healthcare Administration, Criminal Justice, or a related field preferred
4+ years of experience in healthcare fraud, waste and abuse (FWA) prevention, investigations, compliance, auditing, or related risk functions preferred
Proficiency in Microsoft Excel, Microsoft Word, and experience with reporting tools, case management systems, and audit documentation platforms
Strong analytical, investigative, and critical-thinking skills, with the ability to evaluate complex data and identify potential fraud, waste and abuse trends
Excellent written and verbal communication skills, with the ability to clearly articulate findings to internal stakeholders and external clients
Demonstrated ability to manage multiple priorities in a fast-paced, deadline-driven environment
Highly detail-oriented, with a strong commitment to accuracy, documentation standards, and regulatory compliance
Proven problem-solving skills and sound professional judgment in handling sensitive or ambiguous situations
Collaborative mindset with the ability to work effectively across cross-functional teams

Nice To Haves

Professional certifications such as Certified Fraud Examiner (CFE), Accredited Health Care Fraud Investigator (AHFI), or comparable credentials preferred

Responsibilities

Apply advanced professional knowledge to effectively manage complex fraud, waste, and abuse concerns involving prescriber and pharmacy activity on behalf of client needs and expectations, independently and with minimal management oversight.
Identify and recommend solutions to improve SIU workflows and address operational weaknesses through process improvement initiatives.
Assist with training, case staffing, and End2End review support for new and seasoned investigators on an ongoing basis.
Work independently and collaboratively with internal and external business partners to oversee and execute projects and requests responsive to client needs.
Collaborate with fraud leadership and cross-functional partners to identify trends, mitigate emerging risks, and enhance enterprise fraud prevention strategies.