Pharmacy Fraud Investigator-Remote

Job Summary:

T his role will also oversee multiple investigations as it relates to pharmacy and patient outreach and must coordinate the successful transfer of essential case data between the partner and the SIU.

Essential Functions:


* Directly interact with multiple levels within partner organization to coordinate Fraud Waste and Abuse activities.

Interactions will include meetings with attendees including partner Senior Managers and Directors.


* Coordinate multiple investigations to manage investigative outreach and communicate case details between external and internal investigators.


* Facilitate triage and coordination of partner fraud tips and communicate the outcomes in an intelligent, professional, and informed manner.


* Work with partner and SIU management to proactively seek out process improvement as the relationship matures and areas of opportunities are identified.


* Understand back-end systems and reporting processes to troubleshoot gaps or issues.

QUALIFICATIONS


* College degree in related field preferred or 3+ years of equivalent work experience


* Relevant experience as a Fraud Investigator in healthcare


* Certified Pharmacy Technician, Certified Fraud Examiner, or similar certification strongly desired.


* Highly proficient in Microsoft Access & Excel, and data warehousing applications.


* Excellent organizational and interpersonal skills, critical thinking and planning skills, verbal and written communication skills.


* Ability to present to clients and internal stakeholders.


* Ability to work well with senior management and high level external contacts, handle sensitive or confidential information is critical, work with minimum management oversight on multiple projects with competing priorities.


* Ability to work a flexible schedule to accommodate project deadlines.

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 64,700 - 107,900 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 The Cigna Group

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