Quality Review and Audit Senior Analyst

Subrogation Senior Analyst – Payment Integrity The job profile for this position is Quality Review and Audit Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.

Role Summary: As Subrogation Senior Analyst within Payment Integrity Team, you will be responsible for identifying, pursuing, and recovering medical claim costs from liable third parties (e.g., motor insurers, other liability insurers, statutory schemes). The role ensures financial recovery, regulatory compliance, and timely resolution of subrogation cases across jurisdictions. Identify subrogation opportunities through medical claims review and accident indicators Assess liability scenarios (motor vehicle accidents, third‑party negligence, etc.) Contact customers to validate liability and obtain required documentation (e.g. police report) Prioritize cases based on recoverability, value, and limitation period Prepare and raise subrogation claims supported by medical documentation and legal basis Liaise with third‑party insurers, employers, TPAs, and legal representatives Negotiate settlements in line with policy terms and jurisdictional rules Apply country‑specific subrogation laws, reimbursement rights, and statutory scheme Monitor limitation periods and ensure timely action Ensure compliance with internal policies, data protection, and audit requirements Coordinate with external recovery vendors and law firms Collaborate with internal teams (Legal, Claims, Customer Service, Account Management, Medical, Legal, Finance) Maintain accurate case notes and recovery tracking Contribute to process improvement initiatives and recovery strategies Partner with Payment Integrity and other teams to raise awareness of schemes that fall under subrogation scope

Required Qualifications & Experience Bachelor’s degree in healthcare administration, or related field Minimum 3 years of experience in subrogation, claims recovery, liability claims, or health insurance operations (Claims and/or Customer Service) Knowledge of Mainframe, Diamond, Actisure and/or Globalcare is preferred

Skills & Competencies Strong analytical and investigative skills Excellent verbal and written communications skills Strong negotiation skills Ability to interpret legal and medical documentation High attention to detail and strong organizational skills Stakeholder and vendor management capability Proficiency in claims systems and Excel / reporting tools Fluent in English, German and/or French are an advantage

Preferred Experience (Nice to Have) Bachelor’s degree in law Knowledge of ICD‑10 billing Experience with data-visualization dashboard (e.g. Qliksense) Strong understanding of: Health insurance policy provisions Third‑party liability principles Motor, public, civil and product liability, and statutory compensation schemes

Experience working with cross‑border or multi‑jurisdictional cases

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.