Senior Medical Cost Analytics Advisor

🔥 9 hours ago

🇺🇸 United States – Remote

💵 $112.8k - $188k / year

⏰ Full Time

🟠 Senior

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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

• Provide strategic and analytical support to the Payment Integrity team • Evaluate pre-payment and post-payment programs, clinical coding audits, and recovery initiatives • Identify opportunities for savings and improved performance • Translate data and program results into actionable insights and business cases • Partner with Finance, Operations, Clinical, Network, Claims, Product, vendor, Contracting, Coverage Policy, Compliance, Network Analytics, Reserving, and Commercial Payment Integrity teams • Identify trends, risks, affordability opportunities, billing patterns, coding and reimbursement dynamics, and wasteful or abusive practices • Own financial impact assessments and business cases, including forecasts, variance analysis, and performance recommendations • Support measurement and performance monitoring through dashboards, scorecards, and executive materials • Identify and size new medical cost analytics opportunities • Support vendor evaluation and sourcing through analysis of negotiations, pricing structures, and performance guarantees • Improve data quality, strengthen controls, and enable scalable self-service reporting through automation and AI-enabled tools • Develop executive-ready insights for technical, operational, and senior leadership audiences

🎯 Requirements

• Bachelor’s degree in a quantitative field (e.g., Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, Applied Mathematics) or equivalent experience • 8+ years of progressive experience in medical cost analytics, payment integrity, financial modeling, or related fields • Strong analytical and technical skills • Hands-on experience using SQL, Excel, SAS, Tableau, Databricks, or similar platforms • Knowledge of reimbursement methodologies and coding, including MS-DRG, APCs, HCPCs, and RBRVS • Familiarity with professional and facility claim constructs • Experience modernizing analytics through automation and AI-enabled or advanced analytics methods, such as predictive modeling, NLP, or machine learning • Ability to translate complex analyses into actionable business insights • Clear, confident communication for senior and executive audiences • Ability to work in regulated and compliance-aware environments • Strong collaboration and influence skills in a matrixed environment • Self-starter orientation toward continuous improvement, ownership, and impact • For home-based work, cable broadband or fiber optic internet with at least 10 Mbps download and 5 Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work from home occasionally or permanently, subject to internet requirements

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