The Cigna Group
Health Service
FraudAnalyst
Neural analysis suggests this role is
optimal for Mid candidates.
“Fraud Analyst at The Cigna Group. Skills: Fraud, Waste or Abuse (FWA) investigations, Data mining, Negotiation with out-of-Network providers. Detecting and recovering FWA payments for non-network claims. Creating solutions to prevent claims overpayment and future spend monitoring”
What You'll Achieve.
Supporting Cigna’s affordability commitment; Prevent claims overpayment; Prevent future spend monitoring; Ensure timeliness and accuracy of PI claims review process
Industry & Context.
Critical mind-set with ability to identify cost containment opportunities
Abide by local regulations including but not limited to data residency restriction
What They're Looking For.
Must Have
3 - 5 years of health insurance or health care provider experience, Knowledge of claims coding, Knowledge of local regulatory rules, Knowledge of medical policy
Nice to Have
Medical/ paramedical qualification
What You'll Do.
Detecting and recovering FWA payments for non-network claims
Creating solutions to prevent claims overpayment and future spend monitoring
Identify and investigate potential instances of medical fraud
waste or abuse (FWA) or error
Perform a variety of prepay focused cost avoidance activities
Seek recovery of FWA payments from claim submissions
Ensure PI savings are tracked and reported accurately
Negotiation with out-of-Network providers
Perform data mining to reveal FWA trends and patterns
Provide investigation reports to internal and external stakeholders
Abide by local regulations including but not limited to data residency restriction
Work on subrogation as needed for local claims in KSA
How You'll Work.
Team & Collaboration
Work closely with other PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, Product and International Member Investigation Unit (MIU); Partner with Cigna TPAs on FWA investigations; Partner with Payment Integrity teams in other locations to share FWA claiming schemes; Partner with Data Analytics team in building future FWA triggers automation; Liaising with internal stakeholders; Work with global teams
Communication Scope
Excellent verbal and written communication skills
Process & Methodology
Deliver on tight timelines
Full Job Description
## About Cigna Healthcare Cigna Healthcare is a global health service company dedicated to transforming healthcare. With roots in the U.S. and operations in over 30 countries, we serve more than 180 million customers and patients worldwide. Ranked 13th on the Fortune 500 in 2025, Cigna is recognized as one of the most trusted and influential names in the industry. Our mission is to improve the health, well being, and peace of mind of those we serve. Cigna Saudi Arabia, a branch of Cigna Worldwide Insurance Company, and the first foreign company license by Insurance Authority in KSA, is committed to delivering best-in-class health solutions aligned with Vision 2030. You’ll join a globally recognized organization where trust, clear communication, and a positive culture shape how we work. Our leaders are consistent, approachable, and supportive, helping you maintain balance while doing meaningful work. We look for people who thrive in collaborative environments, care about meaningful change, and want to grow in a company that puts people first. At Cigna Healthcare, your work contributes to better care experiences and supports customers through important moments in their lives. ## About the Role As Medical Fraud Analyst within Payment Integrity FWA Team you will be directly supporting Cigna’s affordability commitment within Cigna International's business within KSA. This role is responsible for detecting and recovering FWA payments for non-network claims, creating solutions to prevent claims overpayment and future spend monitoring within a dedicated region. He/she will work closely with other PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, Product and International Member Investigation Unit (MIU) ## _What You’ll Do :_ * Identify and investigate potential instances of medical fraud, waste or abuse (FWA) or error across all Cigna’s International Markets books of business for claims incurred in a dedicated region. (KSA) *
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