Medical Fraud Senior Analyst Payment Integrity FWA Regional Team📣 Job Ad

About the Medical Fraud Senior Analyst Role

The Cigna Group is seeking a Medical Fraud Senior Analyst to join its Payment Integrity FWA Team in Riyadh. This full-time role is a Band 3 Senior Contributor Career Track position, focused on supporting Cigna International's affordability commitment within the Kingdom of Saudi Arabia. The position requires 5-10 years of experience and offers a professional environment where employees are encouraged to grow.

Role Summary and Context

As a Medical Fraud Senior Analyst, you will play a critical role in detecting and recovering fraudulent, wasteful, or abusive (FWA) payments for non-network claims. Your responsibilities will include developing solutions to prevent claim overpayments and monitoring future spend within a designated region. You will collaborate with various internal teams, including Payment Integrity, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, Product, and the International Member Investigation Unit (MIU). This role reports locally to the Head of Operations in KSA, with functional reporting to the Global Payment Integrity Team to ensure alignment with Cigna Group standards.

Key Responsibilities

• Identify and investigate potential instances of fraud, waste, abuse (FWA), or error across Cigna’s International Markets for claims incurred in a dedicated region.
• Perform prepay focused cost avoidance activities.
• Seek recovery of FWA payments from claim submissions.
• Independently 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 define actionable steps.
• Ensure Payment Integrity (PI) savings are accurately tracked and reported.
• Partner to implement solutions and drive execution to prevent claims overpayment and unnecessary claim spend, ensuring timeliness and accuracy of PI claims review.
• 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 trigger automation.
• Provide investigation reports to internal and external stakeholders according to regulatory guidelines.
• Adhere to local regulations, including data residency restrictions.
• Work on subrogation as needed for local claims in KSA, in collaboration with the Compliance team.

Qualifications and Experience

• Minimum of 5-10 years of experience in a relevant field.
• Minimum of 4 years of health insurance or health care provider experience.
• Experience in investigation within payment integrity or a similar discipline.
• Knowledge of claims coding, local regulatory rules, and medical policy.
• Experience with data analytics.
• 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.
• Strong organization skills and attention to detail.
• Ability to quickly learn new and complex tasks and concepts.
• Excellent verbal and written communication skills.
• Ability 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.
• A proactive approach and the ability to work effectively within a high-performing team environment.

Work Environment and Location

This is a full-time position based in Riyadh. The role involves working within a team of high performers who hold each other accountable for achieving their best. You will have the opportunity to collaborate with global teams, requiring flexibility and adaptability to different time zones.