Business Analytics Advisor-Payment Integrity Team (Hybrid) (Finance)

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Role Description:

This role will support Payment Integrity projects through analysis of medical expense to determine total medical cost (TMC) savings for both proposed and implemented initiatives and performance of existing programs. Conduct moderate to complex data analysis projects and/or reporting as well as understanding and presenting results and opportunities to key matrix partners at various levels of the organization. This individual will partner with network and Clinical Operations, Payment Policy Unit, and other matrix partners to understand how proposed initiatives will work, how the actual savings will be tracked, and analyze the current medical expense to estimate annual savings from the proposed changes. This role also will assist in building tools and reports to track medical cost expense and highlight emerging trends and outliers.

Responsibilities:

• Position will act as a key subject matter expert for the Payment Integrity team in regards to medical expense analysis and current program maintenance
• Works closely with teams of internal SMEs, project managers, medical directors and others involved in the evaluation to develop rules and assumptions and to provide an accurate assessment of the potential savings for policy changes and total medical cost initiatives.
• Design and maintain dashboards and reports using Tableau or other data visualization tools.
• Monitor program performance using KPIs and dashboards, monitor operational performance of initiatives and adjust strategies based on evolving business needs or regulatory changes.
• Analyze large-scale healthcare datasets (e.g., claims, utilization, provider performance) to identify trends, cost drivers, and opportunities for intervention
• Regularly monitors results, efficiently addresses variance and implements corrective action
• Support medical cost trend reduction by transforming data into actionable reports and dashboards which provide insight into TMC savings opportunity
• Track performance of TMC initiatives and policy changes post implementation.
• Use SAS, SQL or other related applications to query claims data and convert data into meaningful information.
• Support identification of affordability initiatives through analysis of outlier trends and review of competitive policy.
• Understand and present medical cost results to key matrix partners at various levels of the organization.

Qualifications:

• Bachelor's degree in Statistics, Mathematics, Economics, Health Policy Analysis, Finance or equivalent.
• 5+ years of experience with health care analytics required. Experience with medical cost trend analysis preferred.
• Strong analytical and problem-solving skills with a proven track record of success.
• Ability to independently perform data analysis while managing multiple projects and meeting strict deadlines.
• Strong ability to validate and interpret results.
• Ability to understand and interpret key drivers and actionable levers.
• Strong communication skills to include written, oral, and group presentation.
• Comfortable working in fast paced environment
• Understanding of healthcare data, systems, and applications for claims payment, eligibility, benefit design, and clinical data.
• Knowledge of provider contracting terms and methodologies a plus
• Knowledge of medical coverage and reimbursement policy concepts a plus
• Technical sophistication with various data mining and business intelligence tools such as SAS, SQL, Teradata or similar products, advanced Microsoft Excel and/or Tableau skills a plus.
• Knowledge of standard medical coding including DRG, ICD-10, CPT, and HCPCS

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 96,000 - 160,000 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.