Fraud Analyst

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)
• 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.
• Work in partnership to implement solutions and drive execution to prevent claims overpayment, unnecessary claim spends and ensure timeliness and accuracy of PI claims review process.
• Negotiation with out-of-Network providers.
• Perform data mining to reveal FWA trends and patterns.
• 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.
• 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 in collaboration with Compliance team.

What You’ll Bring

• You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best.
• Experience of investigation within payment integrity or similar discipline.
• 3 - 5 years of health insurance or health care provider experience.
• Knowledge of claims coding, local regulatory rules and medical policy.
• Medical/ paramedical qualification is a definite plus.

Skills :

• Critical mind-set with ability to identify cost containment opportunities.
• Experience with data analytics.
• Demonstrated strong organization skills.
• Strong attention to detail.
• Ability to quickly learn new and complex tasks and concepts.
• Excellent verbal and written communication skills.
• Ability to balance multiple priorities at once and deliver on tight timelines.
• Flexibility to work with global teams and varying time zones effectively.
• Experience in liaising with internal stakeholders and ability to work independently within a cross functional team.
• Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines.
• Fluency in Arabic in addition to fluent English is a must.

About The Cigna Group

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.