Miami-Dade County, Florida, United States · Hybrid
The job profile for this position is Fraud Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of…
Skills: Spanish Fluency, Fraud Investigation, Data Analysis, Audit Support, Evidence Preparation
Marshall Township, Pennsylvania, United States · On-site
The job profile for this position is Pharmacy Production Clerk Representative, which is a Band 1 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive …
Skills: Order Packing, Shipment Preparation, Quality Control, Inventory Verification, Labeling
Bangalore North, Karnataka, India · On-site
Job Title: ETL Tester] Location: Bangalore Role Summary: Reporting to the QA Manager, the ETL Tester is responsible for the timely planning, execution, and reporting of Quality Assurance testing activities for new and en…
Skills: ETL Testing, SQL, Python, Data Validation, Test Automation
Kuala Lumpur, Gorontalo, Indonesia · On-site
The job profile for this position is Claims Senior Representative, which is a Band 2 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one …
Skills: Medical Claims Processing, Claims Adjudication, Stakeholder Management, Team Training, Mentorship
Bangalore North, Karnataka, India · On-site
The job profile for this position is Data Engineering Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to he…
Skills: AWS, Terraform, Python, PySpark, SQL
Bangalore North, Karnataka, India · On-site
The job profile for this position is Claims Representative, which is a Band 1 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our …
Skills: Claims Processing, Medical Terminology, Microsoft Office, Written Communication, Verbal Communication
Hyderabad, Telangana, India · Hybrid
The job profile for this position is HIH - Software Engineering Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible …
Skills: C# .NET, SQL, jQuery, Javascript, Full Stack Development
Massachusetts, United States · Remote OK
$20/hr–$30/hr
The job profile for this position is Pharmacy Technician Senior Representative, which is a Band 2 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive…
Skills: Patient Communication, Problem Solving, Data Entry, Prescription Processing, Customer Service
Bloomfield, Connecticut, United States · Remote OK
$108k–$181k/yr
The job profile for this position is User Experience Design Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to h…
Skills: Customer Engagement Strategy, Behavioral Science, A/B Testing, Customer Journey Mapping, Multichannel Marketing
Mississauga, Ontario, Canada · Hybrid
$30/hr–$33/hr
The job profile for this position is Quality Review and Audit Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible st…
Skills: Pharmacy Auditing, Claim Verification, Analytical Skills, Investigative Skills, Regulatory Compliance
Memphis, Tennessee, United States · On-site
The job profile for this position is Pharmacy Production Clerk Representative, which is a Band 1 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive …
Skills: Pharmacy Operations, Quality Control, Shipping and Receiving, Packaging, Inventory Management
United States · Remote Solely
$208k–$346k/yr
Do you crave an intellectually stimulating role that lets you apply your clinical expertise while continuing to grow and make an impact? As a Medical Director at EviCore, part of Evernorth Health Services, a division of …
Skills: Clinical Judgment, Medical Case Review, Peer-to-Peer Consultation, Evidence-Based Medicine, Otolaryngology Expertise
United States · Remote Solely
$208k–$346k/yr
Do you crave an intellectually stimulating role that lets you apply your clinical expertise while continuing to grow and make an impact? As a Medical Director at EviCore, part of Evernorth Health Services, a division of …
Skills: Medical Case Review, Clinical Judgment, Peer-to-Peer Consultation, Evidence-Based Medicine, Utilization Review
Hyderabad, Telangana, India · On-site
Application & Production Support Perform production fixes including troubleshooting with technology and business partners through solution implementation and validation.Coordinate with upstream/downstream systems for iss…
Skills: Production Support, Troubleshooting, Application Maintenance, Performance Tuning, Automation
Antwerp, Antwerp, Belgium · On-site
The job profile for this position is Account Management (IC) Lead Associate, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible str…
Skills: Account Management, Client Relationship Management, Broker Management, Data Analysis, Contract Negotiation
Santa Barbara, California, United States · Hybrid
$42/hr–$70/hr
Home Infusion Registered Nurse – Accredo Specialty Pharmacy-32 Hours Join Accredo Specialty Pharmacy, part of Evernorth Health Services, and bring your nursing expertise to patients where they feel most comfortable—their…
Skills: IV Infusion, IV Insertion, Patient Assessment, Clinical Decision-Making, Care Coordination
Hyderabad, Telangana, India · Hybrid
The job profile for this position is HIH - Software Engineering Manager, which is a Band 4 Management Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help …
Skills: IT Leadership, Agile Development, System Design, Application Development, Vendor Management
Hyderabad, Telangana, India · Hybrid
The job profile for this position is HIH - Agile Product Management Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible str…
Skills: Agile Product Management, SAFe, Jira, Product Roadmap Creation, Backlog Grooming
Hyderabad, Telangana, India · On-site
The job profile for this position is HIH - QA & Testing Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to …
Skills: QA Leadership, Salesforce Testing, Test Automation, Selenium, Cucumber
Hyderabad, Telangana, India · On-site
The job profile for this position is HIH - Application Development Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possib…
Skills: Hyperion HFM, FCCS, ARCS, EDMCS, EPBCS
Miami-Dade County, Florida, United States • Hybrid
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
Conduct and support audits and investigations into potentially fraudulent healthcare claim activity by providers. Prepare evidence packages for law enforcement and state bureaus and represent the company as a witness in judicial proceedings.
Requires a bachelor's degree in Criminal Justice or a related field and bilingual proficiency in Spanish. Candidates should have 1+ years of professional experience, preferably in health insurance investigations, and reside near South Florida.
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
Are you ready to launch your Healthcare Fraud Investigator career and make a real difference? If you're a recent college graduate eager to take the first step in your professional journey, this early‑career opportunity is designed for you.
This is a fantastic opportunity for someone with a Bachelors degree in Criminal Justice and is early in their career seeking to grow in a dynamic organization.
As a Junior Fraud Investigator for Cigna's Special Investigations Unit, you’ll support our 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.
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
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
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
The Cigna Group is a global health company committed to creating a better future built on the vitality of every individual and every community. We relentlessly challenge ourselves to partner and innovate solutions for better health. The Cigna Group includes products and services marketed under Cigna Healthcare, Evernorth Health Services or its subsidiaries. The Cigna Group maintains sales capabilities in more than 30 countries and jurisdictions, and has more than 190 million customer relationships around the world.
Offices: 900 Cottage Grove Rd, Bloomfield, Connecticut 06002, US
The Cigna Group is a global health company committed to creating a better future built on the vitality of every individual and every community. We relentlessly challenge ourselves to partner and innovate solutions for better health. The Cigna Group includes products and services marketed under Cigna Healthcare, Evernorth Health Services or its subsidiaries. The Cigna Group maintains sales capabilities in more than 30 countries and jurisdictions, and has more than 190 million customer relationships around the world.
Offices: 900 Cottage Grove Rd, Bloomfield, Connecticut 06002, US
