Pharmacy Fraud Senior Analyst-Evernorth-Remote

Job Description:

The Investigator role is responsible for the development, investigation, and presentation of complex fraud and/or abuse cases.

Using analytical skills, in-depth drug and medical expertise, and audit tools, independently develop and execute investigation plans including the scope of procedures necessary to address risks in order to formalize sound recommendations for the investigation.

A substantiated case, subject to certain criteria, will result in an in-depth referral to commercial and government clients.

Key Responsibilities:


* Analyze information gathered by investigation and report findings and prepare written summary/recommendations


* Lead virtual interviews of member/providers and pharmacies as necessary to obtain necessary information regarding the investigation


* Prepare reports to expedite tracking and reporting of investigations


* Prepare evidence package referrals to internal and external parties including; contract holders, law enforcement agencies/medical boards

Minimum Requirements:


* Clear and concise verbal and written communication skills


* Strong computer skills are required - Excel, Access and Word


* 2 + years Fraud Investigative or Pharmacy experience


* Bachelor's Degree and/or pharmacy benefit management experience in lieu of degree

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.

About The Cigna Group

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: 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 quali...