Fraud Senior Advisor – Special Investigations Unit (SIU) Matter Resolution

Fraud Senior Advisor – Special Investigations Unit (SIU) Matter Resolution

Our organization is a leader in healthcare services, committed to integrity, innovation, and excellence. We strive to protect our members and partners through robust compliance and fraud prevention programs, fostering a culture of accountability and collaboration.

Position Overview

The Fraud Senior Advisor – Special Investigations Unit (SIU) Matter Resolution plays a critical role in negotiating settlements, advising investigative teams, and ensuring compliance with legal and regulatory standards. This position develops strategies to resolve disputes, recover overpayments, and minimize legal exposure while collaborating with internal and external stakeholders.

Key Responsibilities

• Provide guidance to SIU investigative teams to ensure consistent handling of investigations and proper evidence collection.
• Develop and execute strategies to resolve disputes with providers, recover overpayments, and minimize legal exposure.
• Negotiate settlements and corrective action plans with support from investigators, Medical Directors, and subject matter experts.
• Collaborate with Legal on litigation matters and special projects, maintaining awareness of legal principles impacting SIU operations.
• Support relationships with law enforcement, prosecutorial authorities, and departments of labor to enhance matter resolution and recovery efforts.
• Work with Legal, Compliance, Provider Contracting, Public Affairs, and Sales to provide customer-centric messaging on complex matters.
• Maintain active participation in industry and trade associations, including the National Healthcare Anti-Fraud Association (NHCAA).

Qualifications

• Law degree required.
• 5+ years’ experience resolving legal disputes through settlement or litigation.
• Strong analytical and communication skills.
• Ability to manage a large volume of matters and perform at a high level in a dynamic team environment.

Core Competencies

• Negotiation and Conflict Resolution: Skilled in achieving favorable outcomes in complex disputes.
• Legal Acumen: Deep understanding of legal principles and regulatory requirements.
• Collaboration: Builds strong relationships across internal and external stakeholders.
• Strategic Thinking: Anticipates challenges and develops proactive solutions.
• Communication: Delivers clear, concise, and persuasive messaging.

Candidates who reside within 50 miles of Bloomfield, CT may be asked to work a hybrid, in office/work from home, flexible arrangement.

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 104,900 - 174,800 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.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna Group.

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

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.