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The job profile for this position is Quality Review and Audit Senior Supervisor, which is a Band 3 Management Career Track Role.
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As a Quality Review & Audit Senior Supervisor within the Payment Integrity FWA Team you will be directly supporting Cigna’s affordability commitment within Cigna International’s business. This role is responsible for managing a team accountable for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring. He/ She will work closely with other PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, Product and International Markets Special Investigation Unit (SIU).
- Lead the Quality Assurance and Audit team who are responsible for identifying and preventing fraudulent, wasteful and abusive expenses within Cigna’s International Business Market ensuring team targets and KPIs are met.
- Works closely with PI FWA senior management to understand strategy and is responsible for executing departmental plans and priorities.
- Create solutions and drive execution to prevent claims overpayment, unnecessary claim spend, and ensure timeliness and accuracy of PI claims review process.
- You will perform a variety of pre and post-pay focused cost avoidance activities including identifying and investigating suspected aberrant behaviour, data-mining to reveal FWA trends and patterns and conducting provider onsite and offsite audits.
- Performs verification of services and charges and negotiates with providers contracted by Cigna or out-of-Network providers.
- Ensure PI savings are tracked and reported accurately.
- Recommends changes in policy and procedures in order to mitigate risk and participates in projects to improve business protocols.
- Provides input into workforce planning and recruitment activities and addresses resource and operational challenges.
- Works collaboratively in a team environment to efficiently utilize each individual’s strengths.
- Working closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers.
Skills and Requirements:
- Experience of leading operational teams. You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best
- Minimum of 2 years of health insurance or health care provider experience in Africa or the Middle East.
- Knowledge of claims coding, regulatory rules and medical policy.
- Medical/ paramedical qualification is a definite plus.
- Passive knowledge of medical terminology and treatment modalities.
- Critical mind-set with ability to identify cost containment opportunities.
- Strong reporting and analytical skills with ability to create and improve reporting packs and methodologies with some support.
- An experience with data analytics tool(s) is a strong asset.
- Excellent verbal and written communication, interpersonal and negotiation skills.
- Ability to balance multiple priorities at once and deliver on tight timelines.
- Flexibility to work with global teams and varying time zones effectively.
- Confidence to deal with internal stakeholders and ability to work with a cross functional team.
- Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines.
- Fluency in foreign languages in addition to fluent English is a strong plus.
About Cigna Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?