Fraud Senior Supervisor

<p><b>Fraud Senior Supervisor </b></p><p><span>The job profile for this position is Fraud Senior Supervisor, which is a Band 3 Management Career Track Role.</span></p><p></p><p><b><span>Role Summary:</span></b></p><p>As a Fraud Senior Supervisor within the Member Investigation Unit you will be directly supporting Cigna’s affordability commitment within Cigna International's business <span>and have specific responsibility for the quality and effectiveness of investigations into suspected member behaviours.</span> This role is responsible for managing a team accountable for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring. <span>This role will partner with internal stakeholders and specifically Client Management Teams to demonstrate good practice anti-fraud services, compliance with global regulatory and legislative requirements and will </span>maintain integrity of all investigative data and reports. He/ She will work closely with other PI team members, Medical Economics, Data &amp; Analytics, Claims Operations, Clinical partners and Product.</p><p></p><p></p><p><b><span>Responsibilities:</span></b></p><ul><li><span>Lead the Member Investigation Team who are responsible for identifying and preventing fraudulent, wasteful and abusive expenses within Cigna’s International Business Market ensuring team targets and KPIs are met. </span></li><li><span>Works closely with PI FWA senior management to understand strategy and is responsible for executing departmental plans and priorities. </span></li><li><span>Responsible for representing the Payment Integrity function when engaging with external clients and reporting to and informing clients of their fraud risks.   </span></li><li><span>Accountable for managing internal stakeholder relationships.</span></li><li><span>Coach, support and provide appropriate case guidance, to Investigators ensuring compliance with investigation standard operating models.</span></li><li><span>Ensure department KPIs are met through effective monitoring and reporting mechanisms; ensure PI savings are tracked and reported accurately.</span></li><li><span>Executes strategic initiatives, plans, and goals in alignment with department KPIs and financial targets. </span></li><li><span>Effectively use business intelligence and data analytics to monitor PI FWA regional claim patterns and identify opportunities for PI intervention and liaises with the Data &amp; Analytics team to develop FWA rulesets.  </span></li><li><span>Ensures Payment Integrity processes are in compliance with legal, regulatory and contractual requirements.</span></li><li>Acts with urgency when there is an elevated risk of fraud against Cigna and its customers and clients.</li><li>Ensures investigative findings are documented and that all communications with clients are fact based and professional.</li><li><span>Assess work demand against capacity to ensure optimum claim referrals across all referral routes; create solutions, drive execution and ensure timeliness and accuracy of PI claims review process, loss prevention and recovery activity. </span></li><li><span>Instils work culture of continuous process improvement, innovation, and quality. </span></li><li><span>Oversee departmental personnel matters; evaluating staff performance and conducting performance appraisals for all direct reports. Ensure adherence to company practices and procedures.</span></li><li><span>Recommends changes in policy and procedures in order to mitigate risk and participates in projects to improve business protocols.</span></li><li><span>Provides input into workforce planning and recruitment activities and addresses resource and operational challenges.  </span></li><li><span>Working closely with other departments to ensure Payment Integrity activities do not have an unnecessary negative impact on our customers.</span></li></ul><p></p><p><b><span>Skills and Requirements:</span></b></p><ul><li><span>Experience of leading operational teams. You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best</span></li><li>An accredited counter fraud qualification.</li><li><span>Minimum of 5 years of health insurance or international health care provider experience.</span></li><li><span>Experience of operational risk management, including internal and external risk and compliance reporting.</span></li><li><span>Knowledge of claims coding, regulatory rules and medical policy.</span></li><li><span>Medical/ paramedical qualification is a definite plus.</span></li><li><span>Customer Focus – dedicated to meeting the expectations and requirements of internal and external customers, excellent at building effective relationships and gaining trust and respect.</span></li><li><span>Passive knowledge of medical terminology and treatment modalities.</span></li><li><span>Critical mind-set with ability to identify cost containment opportunities.</span><