Fraud Senior Supervisor

Fraud Senior Supervisor

Band 3 – Management Career Track

Role Summary

The Fraud Senior Supervisor is a leadership role within the Payment Integrity (PI) Team, directly supporting Cigna’s affordability commitment across Cigna International. This position holds primary accountability for the quality, effectiveness, and outcomes of Fraud, Waste, and Abuse (FWA) investigations.

The role leads a team responsible for detecting, preventing, and recovering FWA-related payments, developing solutions to mitigate claims overpayments, and monitoring future spend. The Fraud Senior Supervisor works closely with regional prepay teams and partners extensively with internal stakeholders—particularly Client Management Teams—to demonstrate best‑practice anti‑fraud services, ensure compliance with global regulatory and legislative requirements, and maintain the integrity of investigative data and reporting.

This role collaborates cross‑functionally with other Payment Integrity team members, Medical Economics, Data & Analytics, Claims Operations, Clinical partners, and Product teams to drive effective and compliant fraud prevention strategies.

Key Responsibilities

• Lead the Payment Integrity Investigation Team responsible for identifying and preventing fraudulent, wasteful, and abusive activity within Cigna’s International Business, ensuring all team targets and KPIs are achieved.

• Partner closely with PI FWA senior leadership to understand strategic objectives and execute departmental plans and priorities.

• Represent the Payment Integrity function in engagements with external clients, including communicating fraud risk exposure and reporting investigation outcomes.

• Build, manage, and maintain strong internal stakeholder relationships across the organization.

• Coach, support, and provide case guidance to investigators, ensuring adherence to investigation standards and operating models.

• Monitor performance through robust reporting mechanisms to ensure departmental KPIs are met and PI savings are accurately tracked and reported.

• Execute strategic initiatives in alignment with departmental KPIs, financial goals, and enterprise objectives.

• Leverage business intelligence and data analytics to identify regional FWA trends and opportunities for PI intervention; collaborate with Data & Analytics to develop and refine FWA rulesets.

• Ensure all Payment Integrity processes comply with legal, regulatory, and contractual requirements.

• Act with urgency and sound judgment in response to elevated fraud risks impacting Cigna, its customers, and clients.

• Ensure investigative findings are thoroughly documented and that all client communications are factual, clear, and professional.

• Assess workload demand against team capacity to optimize claim referrals across all intake channels, ensuring timely, accurate claims review, loss prevention, and recovery activities.

• Foster a culture of continuous improvement, innovation, quality, and accountability within the team.

• Oversee people management responsibilities, including performance management, coaching, and formal appraisals, in alignment with company policies and procedures.

• Recommend enhancements to policies and procedures to mitigate risk and participate in initiatives to strengthen business protocols.

• Contribute to workforce planning and recruitment efforts while addressing operational and resourcing challenges.

• Collaborate with cross‑functional partners to ensure Payment Integrity activities minimize unintended impacts on customer experience.

Skills and Requirements

• Proven experience leading and developing operational teams in a performance‑driven environment.

• Accredited counter‑fraud qualification.

• Minimum of five (5) years’ plus experience within health insurance or international healthcare provider environments.

• Demonstrated experience in operational risk management, including internal and external compliance and risk reporting.

• Strong knowledge of claims coding, regulatory requirements, and medical policy.

• Medical or paramedical qualification strongly preferred.

• Customer‑focused mindset with the ability to build trusted relationships with internal and external stakeholders.

• Working knowledge of medical terminology and treatment modalities.

• Strong critical thinking skills with the ability to identify cost containment and fraud prevention opportunities.

• Advanced analytical and reporting capabilities, including experience developing and enhancing reporting methodologies.

• Experience using data analytics tools is a strong asset.

• Excellent written, verbal, interpersonal, and negotiation skills.

• Ability to manage multiple priorities, work under pressure, and deliver results within tight timelines.

• Flexibility to collaborate effectively with global teams across multiple time zones.

• Confidence engaging with senior stakeholders and working within cross‑functional teams.

• Strong organizational skills with a high attention to detail.

• Fluency in both Spanish and English is a strong advantage.