Healthcare Investigator-Fraud Lead Analyst-Remote

The Fraud Investigator leads in-depth investigations into suspected or confirmed fraud impacting our customers or the company. Using strong judgment and independence, this role identifies the right investigative approach, gathers and analyzes critical information, and drives cases toward resolution and potential restitution. You’ll prepare clear investigative reports, build evidence packages for external partners, and collaborate closely with state and federal agencies. You may also respond to subpoenas and represent the company in legal proceedings. This role requires protecting customer PHI while managing sensitive, high‑value cases. Key Responsibilities:

• Conduct interviews, research, and analysis to resolve fraud allegations.
• Manage complex, high-dollar investigations with minimal supervision.
• Prepare detailed reports and evidence packages for insurance fraud bureaus, contract holders, and law enforcement.
• Coordinate investigations with local, state, and federal agencies.
• Respond to subpoenas and regulatory requests; provide testimony when needed.
• Support special projects involving fraud detection, auditing, and investigative best practices.
• Partner with internal departments while maintaining strict confidentiality standards.

Requirements:

• Bachelor’s degree in Criminal Justice or related field or 7+ years of investigative claims experience.
• 3+ years of health insurance investigation or audit experience strongly preferred.
• Strong computer and analytical skills; proficiency in Microsoft Excel, Access, and Word preferred.
• Excellent written and verbal communication skills.
• Ability to adapt quickly to changing priorities and work independently.

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 require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] 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. Apply tot his job Apply To this Job