This position is a temporary assignment. As a contractor, you’ll be employed by Magnit, not The Cigna Group or any subsidiaries of The Cigna Group.

Job Title:  Quality Review and Audit Lead Analyst

LOCATION & SCHEDULE:
This is a fully remote working role open to candidates across the US.
EST Time Zone 

ROLE OVERVIEW: Quality Review and Audit Prepay Supervisor
(Quality Review and Audit Prepay Supervisor)

As a Quality Review & Audit Supervisor within the Payment Integrity Pre-Payment Team you will be directly supporting Cigna’s affordability commitment within Cigna International's business. 

This role is responsible for leading remote, regionally focused prepayment team members who are responsible for identifying and preventing fraudulent, wasteful and abusive expenses within Cigna’s International Business Market. 

He/ She will work closely with other PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, and Member Investigations Unit (MIU).

RESPONSIBILITIES:

Lead the Regional Prepayment team who are responsible for identifying claims that should not be paid as received and identify claims with potential Fraud, Waste and Abuse savings to meet Provider Integrity targets and KPIs. 

Works closely with Payment Integrity management to understand strategy and is responsible for executing departmental plans and priorities.

Accountable for managing internal stakeholder relationships.

Coach and support all PI Pre-Payment team members to monitor and identify non-compliance in billing and claims payment activity within the international markets. 

Ensure department KPIs are met through effective monitoring and reporting mechanisms; ensure PI savings are tracked and reported accurately.

Executes strategic initiatives, plans, and goals in alignment with department KPIs and financial targets

Ensures payment integrity processes are in compliance with legal, regulatory and contractual requirements.

Assess work demand against capacity to ensure optimum claim referrals across all referral routes; create solutions, drive execution and ensure timeliness and accuracy of PI claims review process. 

Oversee departmental personnel matters; evaluating staff performance and conducting performance appraisals for all direct reports. Ensure adherence to company practices and procedures.

Assist in organizing the on-boarding and training of new hires to the team.

Perform verification of services and charges and in some cases negotiate with providers contracted by Cigna or out-of-Network providers.

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.  

Providing feedback to other departments in order to put in place safeguards to prevent further risk exposure

Working closely with other departments to ensure Payment Integrity activities do not have an unnecessary negative impact on our customers.

SKILLS & QUALIFICATIONS:
Minimum of 2 years of health insurance or international health care provider experience.

Minimum of 1 year of experience work in a Payment Integrity function preferred

Proficiency with Microsoft Excel needed. Word, PowerPoint, Outlook,  and SharePoint preferred

Competent in processing or investigating claims on either the GlobalCare and or Actisure claim platforms

Fluency in foreign languages in addition to fluent English is a strong plus

Knowledge of medical terminology and treatment modalities is a plus.

Data analysis and reporting skills, preferred

Experience processing international claims, preferred

Comfort with telephonic outreaches to global entities, preferred

Demonstrated follow through on complex problems and tasks

Inquisitive nature capable of thinking critically and challenging assumptions

Comfortable working independently and with a team

Flexibility to work with global teams and varying time zones effectively.

Ability to balance multiple priorities at once and deliver on tight timelines

Ability to stay up to date on operations workflows

Ability to develop and effectively communicate presentations and training materials

Strong written and verbal communication skills

Patience and creativity 

Demonstrated strong organizational skills

Strong attention to detail

Ability to quickly learn new and complex tasks and concepts

EDUCATON:

Bachelor’s Degree, preferred

Hourly Pay Rate Range (dependent on location, experience, expectation)  

The pay range that Magnit reasonably expects to pay for this position is $33.00/ hour-$37.00/ hour  

Benefits: Medical, Dental, Vision, 401K (provided minimum eligibility hours are met) 

REF: 36330448