Medical Fraud Senior Analyst Payment Integrity FWA Regional Team📣 إعلان

About the Role

Cigna is seeking a Medical Fraud Senior Analyst to join the Payment Integrity FWA Regional Team. This full-time position, based in Riyadh, will play a crucial role in supporting Cigna International's affordability commitment within the Kingdom of Saudi Arabia. The analyst will be responsible for identifying and recovering fraudulent, wasteful, or abusive (FWA) payments, developing strategies to prevent overpayments, and monitoring future spend within a designated region. This role requires close collaboration with various internal teams, including Payment Integrity, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, Product, and the International Member Investigation Unit (MIU).

Key Responsibilities

• Identify and investigate potential instances of fraud, waste, or abuse (FWA) or error across all Cigna’s International Markets books of business for claims incurred in a dedicated region.
• Perform prepay-focused cost avoidance activities.
• Seek recovery of FWA payments from claim submissions.
• Independently and proactively research and analyze data using appropriate investigative techniques to identify possible FWA cases.
• Identify trends and patterns of insurance fraud through data analysis.
• Collaborate with investigative staff to develop investigative leads and articulate clear action steps.
• Ensure Payment Integrity (PI) savings are tracked and reported accurately.
• Partner to implement solutions and drive execution to prevent claims overpayment and unnecessary claim spends, ensuring timeliness and accuracy of the PI claims review process.
• Negotiate with out-of-Network providers.
• Perform data mining to reveal FWA trends and patterns.
• Partner with Cigna TPAs on FWA investigations.
• Collaborate with Payment Integrity teams in other locations to share FWA claiming schemes.
• Partner with the Data Analytics team in building future FWA triggers automation.
• Provide investigation reports to internal and external stakeholders as per regulatory guidelines.
• Adhere to local regulations, including data residency restrictions.
• Undertake subrogation as needed for local claims in KSA in collaboration with the Compliance team.

Qualifications and Experience

This role requires a candidate with 5-10 years of experience. Ideal candidates will have a background in payment integrity investigations or a similar discipline. A minimum of 4 years of health insurance or health care provider experience is essential. Knowledge of claims coding, local regulatory rules, and medical policy is required. A medical or paramedical qualification is considered a significant advantage.

Required Skills and Attributes

• A critical mindset with the ability to identify cost containment opportunities.
• Experience with data analytics.
• Demonstrated strong organization skills and attention to detail.
• Ability to quickly learn new and complex tasks and concepts.
• Excellent verbal and written communication skills.
• Capacity to balance multiple priorities and deliver under tight timelines.
• Flexibility to work effectively with global teams across varying time zones.
• Experience liaising with internal stakeholders and the ability to work independently within a cross-functional team.
• Fluency in both Arabic and English is mandatory.

Team and Work Environment

The successful candidate will join a team of high performers who are committed to achieving their best. The role operates within a full-time capacity in Riyadh. The position reports locally to the KSA Head of Operations, with functional reporting to the Global Payment Integrity Team to ensure alignment with Cigna group standards.