Business Analytics Advisor-Payment Integrity & Affordability (Hybrid)

This role will support Cost Containment projects through complex analysis of medical expense to determine medical cost savings for both proposed and implemented initiatives. This individual will conduct thorough data analysis projects and act as analytical lead on cost savings initiatives as well as understanding and presenting findings and highlighting opportunities to key matrix partners at various levels of the organization. This role will partner with network and Clinical Operations, Coverage 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 will also be data mining historical claims data to develop algorithms and design tools to track medical cost expense and highlight emerging trends and outliers.

Responsibilities:

• Act as a key subject matter expert in regards to medical expense analysis and sizing of proposed medical policy changes and other cost savings initiatives.
• Work with a range of teams to analyze relevant data, determine cost savings opportunities and identify roadblocks to project implementation.
• Perform complex data analysis and research to support medical cost savings initiatives and policy changes within the commercial and/or Cigna Medicare population.
• Work closely with teams of internal SME, 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.
• Support medical cost trend reduction by data mining large datasets and using complex analytics and/or statistics to identify key drivers of medical trend and anomalous/outlier patterns in claims billing activity.
• Use innovative technology and tools such as Hadoop, SAS, SQL, Tableau or other related applications to query claims data and convert data into meaningful information.
• 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, or Finance or equivalent work experience.
• 5+ years of experience with health care cost analysis required. Experience with medical cost trend analysis preferred.
• Strong analytical and problem solving skills with the ability to create complex algorithms in order to size and identify a variety of cost savings initiatives.
• Ability to independently perform data analysis while managing multiple projects and meeting strict deadlines.
• Ability to understand and interpret key drivers and actionable levers.
• Strong communication skills to include written, oral, and group presentation.
• Strong business acumen with 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
• Technical sophistication with various data mining and business intelligence tools such as SAS, SQL, Teradata or similar products, advanced Microsoft Excel and/or Tableau experience a plus.
• Knowledge of standard medical coding including DRG, ICD-10, 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 98,200 - 163,600 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.

At The Cigna Group, 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), 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, click here .

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: [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.

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.