6 дней назад
Fraud Senior Analyst –Payment Integrity Provider Investigation APAC Team (Healthcare)
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
Текст:
TL;DR
Fraud Senior Analyst –Payment Integrity Provider Investigation APAC Team (Healthcare): Leading fraud, waste, and abuse investigations across international health insurance markets with an accent on provider audits, claims analysis, recoveries, and prevention controls. Focus on translating data insights into automated FWA triggers, managing complex provider relationships, and strengthening compliant payment integrity strategies across diverse regulatory environments.
Location: Kuala Lumpur, Malaysia
Company
Cigna Healthcare, a division of , supports customers through the health care system and helps improve health outcomes.
What you will do
- Lead end-to-end fraud, waste, and abuse investigations across international markets, identifying billing anomalies, emerging fraud typologies, and systemic risks.
- Deliver measurable savings through cost containment, payment recoveries, and forward-looking prevention initiatives.
- Partner with Data Analytics to develop investigation triggers, reporting frameworks, and future FWA automation.
- Conduct provider audit engagements, negotiations, TPA oversight, and collaboration with regional and global stakeholders.
- Produce defensible investigative findings and recommendations while maintaining audit readiness and fair member outcomes.
- Improve Payment Integrity processes, support governance and compliance, and mentor colleagues through knowledge sharing and quality review.
Requirements
- Experience in payment integrity investigations or a similar discipline.
- At least 4 years of experience in health insurance or health care provider environments.
- Knowledge of Mainframe, GlobalCare, Actisure, and/or Diamond, as well as claims coding, regulatory rules, and medical policy.
- Experience with data analytics, strong attention to detail, organization, prioritization, and independent work in cross-functional teams.
- Excellent verbal and written communication skills, with the ability to work effectively across global teams and time zones.
- Fluent English required; additional foreign-language fluency is advantageous.
Nice to have
- Medical or paramedical qualification.
- Experience with provider engagement, audit frameworks, or fraud risk management.
Culture & Benefits
- Work with high-performing colleagues who hold one another accountable.
- Gain exposure to international health insurance investigations and global Payment Integrity frameworks.
- Develop strategic thinking and leadership through complex case ownership and influence without direct people management.
- Build expertise in healthcare claims coding, regulatory considerations, advanced analytics, and fraud risk management.
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