Global Director of Payment Integrity & Investigations (Healthcare)

Location: Madrid, Spain; hybrid workplace

Company

Cigna Healthcare, part of hirify.global, provides international healthcare solutions combining clinical expertise, digital innovation, and operational capabilities.

What you will do

• Define and execute the international Payment Integrity and Investigations strategy, operating model, governance framework, and multi-year roadmap.
• Lead pre-payment controls, post-payment reviews, clinical and coding audits, claims analytics, recovery, and root-cause remediation.
• Direct investigations into suspected fraud, waste, abuse, and error, including case intake, evidence handling, referrals, and closure standards.
• Own prevention, savings, recovery, productivity, quality, cycle-time, and return-on-investment performance metrics.
• Sponsor analytics, machine learning, AI, automation, model governance, and technology-enabled detection capabilities.
• Lead a global multidisciplinary team and partner with Claims, Clinical, Data, Technology, Compliance, Legal, Finance, providers, vendors, and senior executives.

Requirements

• 15+ years of progressive experience in healthcare payment integrity, claims, special investigations, fraud risk, clinical audit, healthcare finance, or related operations.
• Significant experience leading complex multidisciplinary teams and delivering measurable prevention, savings, recovery, quality, and operational outcomes.
• Strong knowledge of healthcare claims, reimbursement, coding, provider billing, clinical review, investigative methods, and fraud, waste, and abuse risks.
• Experience designing operating models, governance frameworks, controls, analytics, and technology-enabled transformation across multiple markets or business lines.
• Understanding of compliance, privacy, evidence handling, regulatory engagement, and legal considerations related to investigations and payment recovery.
• Bachelor's degree in Healthcare Administration, Business, Finance, Clinical Sciences, Data Analytics, Law, Criminal or Forensic Justice, or a related field; international experience and willingness to travel are required.

Nice to have

• Advanced degree or relevant professional certification.
• Additional language capabilities.

Culture & Benefits

• Opportunity to shape Payment Integrity and Investigations across international markets.
• Collaboration across clinical, claims, provider, finance, compliance, and technology disciplines.
• Opportunity to influence senior leadership decisions and enterprise-wide transformation.
• Competitive compensation package and career development within an international healthcare organization.