Managing Director, Special Investigations Unit

Key Responsibilities Strategic Leadership & Enterprise Influence

• Provide strategic oversight of the Special Investigations Unit, setting direction for fraud, waste, and abuse (FWA) prevention, detection, and investigative operations across multiple business segments.
• Align SIU strategy with enterprise objectives, regulatory expectations, and emerging industry risks, ensuring Cigna maintains a leadership position in combating provider and member fraud.
• Collaborate with key internal and external partners to strengthen end‑to‑end fraud controls.
• Prepare and present Annual Anti-Fraud plan, including risks, new and emerging schemes, critical metrics and results.

• Apply deeper proactive analytics across multiple business lines by leveraging advanced modeling, datamart assets, automated detection tools, and scalable analytic infrastructure to strengthen anti‑fraud controls.
• Expand analytic toolsets by optimizing data pipelines, integrating disparate data sources, and ensuring analytic teams have access to modern tools, methodologies, and platforms.
• Ensure AI and machine learning capabilities are effectively leveraged to identify anomalous billing, predictive risk patterns, provider behavior changes, and complex schemes earlier and more accurately.

• Oversee end‑to‑end investigative processes, ensuring consistency, strong documentation, adherence to regulatory requirements, and application of best practices across all investigative teams.
• Consolidate disparate data to increase operational controls, improve tracking of investigative steps, and strengthen day‑to‑day execution.
• Drive proactive resolution of provider billing issues and reduce repeat offenses through education, corrective action, and coordinated intervention strategies.
• Establish performance measures that reinforce quality, timeliness, investigative rigor, and impact.

• Lead through integrity and set a high standard of ethics, accountability, and transparency for the SIU organization.
• Enhance employee engagement, strengthen culture, and foster a sense of purpose within the SIU team by championing talent development, retention, recognition and engagement strategies.
• Optimize talent and retain high performers, ensuring succession planning, technical skill development, and cross‑functional knowledge‑sharing.

• Strengthen outward‑facing SIU reporting, ensuring clients, subsidiaries, and regulators receive accurate, timely, and relevant fraud‑related insights.
• Initiate and lead new client, subsidiary, and vendor initiatives that expand the impact of Cigna’s anti‑fraud work, improve detection and prevention capabilities, and reinforce Cigna’s value proposition in the marketplace.
• Serve as the enterprise spokesperson on FWA trends, operational results, strategic initiatives, and emerging risks for senior leadership, clients, and external partners.

• Ensure SIU operations meet federal, state, and CMS requirements related to fraud, waste, and abuse programs.
• Maintain strong controls, robust audit readiness, and comprehensive documentation to support regulatory inquiries and enterprise risk mitigation.
• Partner with Legal and Compliance to ensure investigative activities, reporting, and corrective action plans are aligned with enterprise policies and industry standards.

• 12+ years of increasing responsibility in fraud, waste, and abuse investigations, audit or health care risk management, including 5+ years of people management experience
• Demonstrated leadership of multi‑disciplinary investigative and analytic teams across complex organizations.
• Deep understanding of CMS, state regulatory, commercial, and government program FWA requirements.
• Deep understanding of health care industry practices
• Exceptional communication skills with the ability to influence senior leaders, external partners, and cross‑functional teams.

• Prior leadership of a large SIU or FWA function within a payer, PBM, government agency,…