Fraud Senior Supervisor - Member Investigation

About the role

Cigna Healthcare is hiring a Fraud Senior Supervisor (Band 3 Management Career Track) for its Member Investigation Unit in Glasgow. The role supports Cigna's affordability commitment in Cigna International and is responsible for the quality and effectiveness of investigations into suspected member behaviour, managing a team that detects and recovers FWA payments and prevents claims overpayments.

Key responsibilities

• Lead the Member Investigation Team in identifying and preventing fraudulent, wasteful and abusive expenses, meeting team targets and KPIs.
• Work with PI FWA senior management on strategy and execute departmental plans and priorities.
• Represent the Payment Integrity function with external clients, report fraud risks and manage internal stakeholder relationships.
• Coach investigators and ensure compliance with investigation standard operating models.
• Monitor and report department KPIs and PI savings, and use data analytics to track regional claim patterns and build FWA rulesets with the Data & Analytics team.
• Ensure processes comply with legal, regulatory and contractual requirements, document findings and keep client communications factual and professional.
• Manage workload and claim referrals, drive timeliness and accuracy of reviews, and foster continuous improvement.
• Oversee personnel matters, including performance appraisals, recommend policy changes and contribute to workforce planning.

Required profile

• Accredited counter fraud qualification.
• Minimum of 5 years of health insurance or international health care provider experience.
• Experience leading operational teams and operational risk management, including internal and external risk and compliance reporting.
• Knowledge of claims coding, regulatory rules and medical policy; medical or paramedical qualification is a definite plus.
• Fluent English; fluency in another language is a strong plus.

Required skills

• Strong reporting and analytical skills, with some support to create reporting packs.
• Experience with data analytics tools is a strong asset.
• Excellent verbal and written communication, negotiation and organisational skills.
• Ability to balance priorities, work under pressure and collaborate with global teams across time zones.

What we offer

• A global, diverse and collaborative environment with exposure to cross-functional teams and strategic projects.
• Support for learning, development and internal career growth.
• A competitive benefits package, including social benefits depending on location.
• Hybrid working and flexible working hours.