Jobs / Spain / Cigna Health And Life Insurance Company
Global Director of Payment Integrity & Investigations
Cigna Health And Life Insurance Company · 🌍 Madrid, Spain
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About the role
About Cigna Healthcare At Cigna Healthcare, we are committed to improving the health, well-being and peace of mind of those we serve. As part of The Cigna Group, we support millions of customers worldwide through innovative healthcare solutions, global expertise and a relentless focus on delivering sustainable, high-quality care. Within Cigna International Health, we help individuals, families and organizations navigate healthcare across borders, combining clinical excellence, digital innovation and operational expertise to create exceptional experiences for our customers and partners around the world. We are looking for leaders who share our passion for transforming healthcare, driving meaningful impact and delivering better outcomes for customers, clients and providers. Position Summary We are seeking an exceptional leader to build and advance the Payment Integrity and Investigations capability across Cigna International Health. Reporting into senior leadership, this role is accountable for protecting healthcare affordability, strengthening payment accuracy, preventing fraud, waste and abuse, and driving measurable financial and operational value across international markets. The Director will define the strategic vision, operating model and future roadmap for Payment Integrity, bringing together data, analytics, clinical expertise, investigations and technology to identify risk, prevent leakage and deliver sustainable outcomes. This is a highly visible leadership position that offers the opportunity to influence enterprise-wide decisions, partner with senior executives and shape one of the most critical affordability capabilities within Cigna International Health. Key Accountabilities Payment Integrity Strategy & Operating Model • Own and execute the international Payment Integrity and Investigations strategy, aligning priorities with affordability objectives, business needs, regulatory requirements and enterprise capabilities. • Design and continuously evolve an integrated operating model spanning pre-payment controls, post-payment review, analytics, investigations, clinical and coding audit, recovery and root-cause remediation. • Establish a multi-year capability roadmap covering people, process, data, technology, governance and external partnerships, with clear investment priorities and measurable outcomes. • Define consistent standards, decision rights, escalation pathways and service expectations across global and regional teams while enabling appropriate local market execution. • Position Payment Integrity as a strategic affordability, risk management and value-creation capability supporting sustainable growth and a differentiated client proposition. Pre-Payment Prevention & Post-Payment Review • Lead the development and optimization of pre-payment edits, clinical rules, coding validations, duplicate-payment controls, tariff and contract checks and other interventions that prevent leakage before payment. • Oversee post-payment analytics, targeted audits, claim reviews and data-mining activities to identify inappropriate payments, emerging patterns and recovery opportunities. • Ensure payment integrity concepts are evidence-based, operationally executable and supported by robust testing, documentation and change management processes. • Partner with Claims, Provider Operations, Network, Clinical, Pharmacy, Data, Technology, Partnerships and Controls teams to embed effective controls into end-to-end workflows. • Drive root-cause analysis and sustainable remediation so identified issues result in improved upstream processes, policies, provider arrangements and system controls. Investigations, Fraud, Waste & Abuse • Lead the Special Investigations capability for suspected fraud, waste, abuse and error involvin