Healthcare Fraud Investigator

Healthcare Fraud Investigator

Make an impact protecting customers, data, and healthcare integrity. We’re looking for a skilled and motivated Healthcare Fraud Investigator to handle complex healthcare fraud matters that impact our customers and the organization. In this role, you’ll take ownership of investigations from start to finish—using sound judgment, analytic thinking, and collaboration to bring cases to resolution. This is an opportunity for investigators who enjoy digging into details, following the data, and working on high‑value cases that truly matter.

What You’ll Do

• Lead in‑depth investigations into suspected or confirmed healthcare fraud, using a thoughtful and independent investigative approach.
• Gather, analyze, and synthesize information from a variety of sources, including claims data, records, interviews, and internal partners.
• Manage complex, high‑dollar investigations with a high degree of autonomy.
• Prepare clear, well‑documented investigative reports and evidence packages to support case resolution, recovery efforts, or external referrals.
• Coordinate with internal stakeholders and, when appropriate, local, state, or federal agencies to support investigations.
• Respond to subpoenas or regulatory inquiries and provide testimony when required, in partnership with legal and compliance teams.
• Support special projects related to fraud detection, auditing, and continuous improvement of investigative practices.
• Protect sensitive customer and company information, including PHI, while maintaining strict confidentiality standards.

What You’ll Bring

• Bachelor’s degree in Criminal Justice or 7+ years of investigative claims experience
• 3+ years of healthcare fraud investigation, SIU, audit, payment integrity, or related experience.
• Proven ability to manage complex investigations independently and bring them to resolution.
• Strong analytical and computer skills, with proficiency in Microsoft Excel, Word, and similar tools.
• Excellent written and verbal communication skills, including the ability to present findings clearly and professionally.
• Comfort working with sensitive, confidential information and exercising sound judgment.
• Ability to adapt to changing priorities and work effectively in a fast‑paced environment.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 68,300 - 113,900 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. Key skills/competency:

• Healthcare Fraud Investigation
• SIU
• Audit
• Payment Integrity
• Claims Analysis
• Investigative Reporting
• Data Analysis
• Legal Compliance
• Confidentiality
• Problem Solving