Medical Fraud Senior Analyst – Payment Integrity FWA Regional Team (Healthcare)

Location: Riyadh, Saudi Arabia

Company

hirify.global provides healthcare and health services through Cigna Healthcare and Evernorth Health Services.

What you will do

• Investigate potential fraud, waste, abuse, and errors across international healthcare claims for a dedicated region.
• Perform prepay cost-avoidance reviews, recover inappropriate payments, and monitor future claims spend.
• Analyze claims data to identify insurance fraud trends, patterns, and investigative leads.
• Negotiate with out-of-network providers and partner with TPAs, investigative teams, and Payment Integrity teams.
• Track and report Payment Integrity savings and prepare investigation reports for internal and external stakeholders.
• Collaborate with Data Analytics on automated FWA triggers and support subrogation for local KSA claims.

Requirements

• Investigation experience in Payment Integrity or a similar discipline.
• At least four years of health insurance or healthcare provider experience.
• Knowledge of claims coding, medical policy, and local regulatory rules.
• Experience with data analytics, strong organization, attention to detail, and the ability to manage multiple priorities independently.
• Fluent Arabic and fluent English are required.
• Ability to work effectively with global teams across varying time zones and comply with local data residency restrictions.

Nice to have

• Medical or paramedical qualification.

Culture & Benefits

• Full-time role within a high-performing, accountable team.
• Collaboration with global Payment Integrity, Analytics, Claims Operations, Clinical, Compliance, Network, and Product teams.
• Professional growth opportunities are supported whenever possible through internal career development.
• Work includes alignment with Cigna Group standards and local regulatory requirements.