Payment Integrity Prepay Fraud Supervisor - Cigna Healthcare (Healthcare)

Location: Kuala Lumpur, Malaysia

Company

Healthcare services organization focused on helping customers navigate the healthcare system and make informed decisions about their health.

What you will do

• Lead the regional prepayment team identifying claims with potential fraud, waste, abuse, and payment-integrity savings.
• Execute departmental strategies, plans, priorities, and financial targets while managing stakeholder relationships.
• Coach team members, monitor billing and claims-payment compliance, and oversee performance reviews, onboarding, and training.
• Track and report KPIs, savings, claim referrals, capacity, timeliness, and review accuracy.
• Verify services and charges, negotiate with contracted and out-of-network providers, and recommend policy and process changes.
• Collaborate with Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, and Member Investigations to reduce risk without negatively affecting customers.

Requirements

• At least 2 years of health insurance or international healthcare provider experience.
• At least 1 year of Payment Integrity experience is preferred.
• Experience processing or investigating claims in GlobalCare or Actisure.
• Strong organization, attention to detail, critical thinking, communication, and follow-through skills.
• Ability to work independently and with global teams across varying time zones while managing multiple priorities and tight deadlines.
• Fluent English; additional foreign-language fluency is a strong plus. Proficiency in Microsoft Excel is required.

Nice to have

• Knowledge of medical terminology and treatment modalities.
• Data analysis and reporting experience.
• Experience processing international claims and conducting telephone outreach to global entities.
• Proficiency in Word, PowerPoint, Outlook, and SharePoint.

Culture & Benefits

• Focus on continuous process improvement, innovation, and quality.
• Work with international markets and globally distributed stakeholders.
• Opportunity to support affordability and reduce unnecessary healthcare payment risk.