Managing Director, Special Investigations Unit

Cigna Group • Bloomfield, CT

17d

About The Position

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. 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. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Requirements

• 12+ years of increasing responsibility in fraud, waste, and abuse investigations, audit or health care risk management, including 5+ years of people management experience
• Demonstrated leadership of multi‑disciplinary investigative and analytic teams across complex organizations.
• Deep understanding of CMS, state regulatory, commercial, and government program FWA requirements.
• Deep understanding of health care industry practices
• Exceptional communication skills with the ability to influence senior leaders, external partners, and cross‑functional teams.
• 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.

Nice To Haves

• Prior leadership of a large SIU or FWA function within a payer, PBM, government agency, or major health care organization.
• Experience integrating AI/ML tools into investigative or operational workflows.
• Strong client‑facing experience, including reporting, vendor management, or consultative support.

Responsibilities

• Provide strategic oversight of the Special Investigations Unit, setting direction for fraud, waste, and abuse (FWA) prevention, detection, and investigative operations across multiple business segments.
• Align SIU strategy with enterprise objectives, regulatory expectations, and emerging industry risks, ensuring Cigna maintains a leadership position in combating provider and member fraud.
• Collaborate with key internal and external partners to strengthen end‑to-end fraud controls.
• Prepare and present Annual Anti-Fraud plan, including risks, new and emerging schemes, critical metrics and results.
• Apply deeper proactive analytics across multiple business lines by leveraging advanced modeling, datamart assets, automated detection tools, and scalable analytic infrastructure to strengthen anti‑fraud controls.
• Expand analytic toolsets by optimizing data pipelines, integrating disparate data sources, and ensuring analytic teams have access to modern tools, methodologies, and platforms.
• Ensure AI and machine learning capabilities are effectively leveraged to identify anomalous billing, predictive risk patterns, provider behavior changes, and complex schemes earlier and more accurately.
• Oversee end‑to-end investigative processes, ensuring consistency, strong documentation, adherence to regulatory requirements, and application of best practices across all investigative teams.
• Consolidate disparate data to increase operational controls, improve tracking of investigative steps, and strengthen day‑to-day execution.
• Drive proactive resolution of provider billing issues and reduce repeat offenses through education, corrective action, and coordinated intervention strategies.
• Establish performance measures that reinforce quality, timeliness, investigative rigor, and impact.
• Lead through integrity and set a high standard of ethics, accountability, and transparency for the SIU organization.
• Enhance employee engagement, strengthen culture, and foster a sense of purpose within the SIU team by championing talent development, retention, recognition and engagement strategies.
• Optimize talent and retain high performers, ensuring succession planning, technical skill development, and cross‑functional knowledge-sharing.
• Strengthen outward‑facing SIU reporting, ensuring clients, subsidiaries, and regulators receive accurate, timely, and relevant fraud‑related insights.
• Initiate and lead new client, subsidiary, and vendor initiatives that expand the impact of Cigna’s anti‑fraud work, improve detection and prevention capabilities, and reinforce Cigna’s value proposition in the marketplace.
• Serve as the enterprise spokesperson on FWA trends, operational results, strategic initiatives, and emerging risks for senior leadership, clients, and external partners.
• Ensure SIU operations meet federal, state, and CMS requirements related to fraud, waste, and abuse programs.
• Maintain strong controls, robust audit readiness, and comprehensive documentation to support regulatory inquiries and enterprise risk mitigation.
• Partner with Legal and Compliance to ensure investigative activities, reporting, and corrective action plans are aligned with enterprise policies and industry standards.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed