Business Analytics Advisor, Payment Integrity

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Expand team expertise in external data sources and claim editing integrations to support scalable solutions. • Standardize and format data for optimal use within claim editing programs, ensuring consistency and efficiency. • Collaborate with the Data Analytics team to develop complex editing logic and proof-of-concept models. • Interpret query languages using data dictionaries and facilitate translation through newly implemented editing tools and data sources. • Lead research and updates for the Unified Claim Record (UCR) and associated data streams. • Partner with cross-functional teams to migrate SAS-based edits to ARM (Claim Editing Platform), driving improved outcomes. • Implement structured, data-driven processes to promote consistent and transparent claim editing practices. • Analyze edit performance to reduce false positives and enhance claim capture accuracy. • Document enhancement needs for claim editing and provide timely input to Scrum technical and product teams. • Support the development and refinement of business rules and editing logic to align with evolving business needs. • Collaborate with matrixed business partners to define data requirements, identify improvement opportunities, and communicate analytical findings and solutions effectively. • Drive enterprise data initiatives focused on improving data quality, governance, traceability, and operational effectiveness. • Support technical modernization efforts through automation, reusable assets, process standardization, and improved analytical capabilities. • Develop and apply statistical models, predictive analytics, and machine learning techniques to identify patterns, trends, anomalies, and opportunities within healthcare claims data. • Design, evaluate, and operationalize AI-enabled and data science solutions that improve payment accuracy, reduce false positives, and enhance claim editing performance. • Perform exploratory data analysis on complex healthcare datasets to uncover actionable insights and develop data-driven recommendations. • Collaborate with data engineering and technology teams to build scalable analytical solutions and reusable data assets. • Evaluate emerging AI, machine learning, and healthcare analytics technologies to identify opportunities for innovation within Payment Integrity. • Support development of proof-of-concept models, pilot initiatives, and advanced analytical frameworks to validate business value and scalability. • Design and execute model validation, performance monitoring, and outcome measurement approaches to ensure analytical solutions deliver expected results. • Develop dashboards, visualizations, and executive-level reporting that communicate analytical findings to both technical and non-technical audiences. • Partner with business stakeholders to transform operational challenges into analytical hypotheses and measurable data science initiatives. • Promote responsible AI practices through governance, data quality management, transparency, model explainability, and compliance-focused solution design. • Leverage AI-assisted analytics, natural language processing, and emerging technologies to improve operational efficiency and decision support. • Identify opportunities to automate manual processes, reduce operational complexity, and accelerate analytical insight generation.

🎯 Requirements

• Demonstrated advanced proficiency with at least 3 years of hands-on experience in data mining, analysis, and processing using tools and languages such as SAS, Altair, SQL, TOAD, Python, R, or comparable technologies. • Bachelor's degree in Business Analytics, Data Science, Information Systems, Computer Science, Statistics, Applied Mathematics, Healthcare Informatics, or a related field preferred. • 7+ years of experience in data analytics, data science, business intelligence, or related analytical disciplines, preferably within healthcare or claims processing. • Proven ability to extract actionable insights using advanced data mining techniques and business intelligence tools to support strategic decision-making. • Strong analytical skills with the ability to translate complex data into meaningful, actionable insights. • Adept at leveraging analytical tools to explore and interpret complex healthcare data, conduct root cause analyses, and deliver actionable insights through clear, data-driven reporting. • Experience applying statistical analysis, predictive modeling, and quantitative problem-solving techniques to complex business challenges. • Strong understanding of machine learning concepts, model development lifecycle, feature engineering, model evaluation, and performance monitoring. • Experience working with large-scale structured and unstructured datasets to identify trends, patterns, risks, and opportunities. • Strong knowledge of data visualization and storytelling techniques utilizing Power BI, Tableau, Python visualization libraries, or similar tools. • Experience in healthcare or managed care environments with direct responsibility for data analysis, data management, and relational database concepts. • Deep understanding of healthcare data and the health delivery system. • Ability to translate analytical findings into business recommendations and influence strategic decision-making. • Excellent communication, presentation, and collaboration skills with the ability to work effectively across technical and business teams.

🏖️ Benefits

• Health insurance • 401(k) • Company paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence