Job Description

Cigna Supplemental Benefits (CSB) provides peace-of-mind and financial security for more than 750,000 policyholders of all ages through Medicare Supplement and Supplemental Health and Life (SHL) products. Our environment is fast paced, the work is meaningful and intense, and our performance expectations are high. The ideal candidate will leverage their creative data insights and advanced analytics skills to ensure CSB is proactively identifying opportunities to reduce fraud, waste, and abuse, improving the lives of the individuals we serve.

The Senior Healthcare Fraud Intelligence Analyst for CSB (Cigna Supplemental Benefits) is responsible for leading fraud detection and analytics for the organization. This position will be responsible for the creation of fraud detection models, utilizing advanced statistical models and machine learning to identify current fraud exposure plus predicting future areas of exposure. This role will work closely with key CSB business stakeholders and leadership to develop a coordinated program to evaluate, monitor, and report on potential FWA risks.

Key Job Functions

• Extract knowledge/insights from disparate data sources to create integrated fraud detection models to support daily fraud review practices

• Lead internal fraud analytics and own output and recommendations to the CSB organization utilizing advanced statistical models and machine learning algorithms

• Make recommendations for process changes based on identified gaps that could lead to fraud exposure for CSB

• Support and grow the compliance and anti-fraud program with the responsibility to perform advanced analysis

• Build machine learning models from design through training, evaluation and implementation

• Work directly with the Special Investigation Unit, providing data and analysis to supported ongoing investigations

• Manages large projects or processes with limited oversight from manager.

• Considered the Subject Matter Expert for Fraud/Waste/Abuse analytics

• Interprets internal or external issues and recommends solutions/best practices.

• Solves complex problems; takes a broad perspective to identify solutions.

• Identifies and develops relationships with internal and external stakeholders to achieve program objectives.

• Communicates routinely with senior leadership team.

Qualifications

• Bachelor's Degree in statistics, mathematics, physics, economics, or other analytical or quantitative discipline. Master's Degree or PhD preferred.

• 5+ years of experience in data analytics and data modeling

• Advanced quantitative/analytics experience

• Hands on experience with both traditional and open source tools:

  • SAS

  • SQL

  • Python

  • R

  • Spark

  • Pytorch

  • Tensorflow

• At least one year of Machine Learning experience, both in the creation and implementation of models in production

• Demonstrated analytic strength related to healthcare data analytics in support of fraud, waste, and abuse issues.

• Handle personal and confidential information with high degree of integrity.

• Highly organized and detail oriented.

• Solid research and communication skills.

• Ability to prioritize workload and adapt to changing and competing priorities.

• Ability to prepare and maintain full and accurate records.

• Ability to work independently and maintain excellent time management skills.

• Excellent interpersonal and relationship management skills.

• Ability to make sound business decisions by analyzing data and key metrics.

• Experience working in a highly matrixed environment, with proven ability to develop strong relationships both internally and externally.

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.

For this position, we anticipate offering an annual salary of 109,100 - 181,800 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.

Job Tags

Holiday work, Full time, Work from home,

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