Senior Business Analytics Advisor – Payment Integrity, Risk & Affordability

🔥 1 hour ago

🐊 Florida – Remote

🐊 Florida – Remote

⏱ Part Time

🟠 Senior

🎲 Risk

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs. • Tell the story behind the data, translating complex findings into clear, executive-ready insights for technical, operational, and senior leadership audiences to short the strategic roadmap. • Own financial impact assessments and business cases for initiatives, including forecasts, variance analysis, and recommendations to improve performance. • Support program measurement and performance monitoring for pre-payment and post-payment editing, coding audits, and recovery programs across dashboards, scorecards, and executive materials. • Identify and size new opportunities by assessing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices. • Partner across the enterprise (e.g., Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product) to align insights to decisions and execution. • Support vendor evaluation and sourcing through data-driven analysis that informs negotiations, pricing structures, and performance guarantees. • Advance reporting and analytics by improving data quality, strengthening controls, and enabling scalable/self-service solutions through automation and thoughtful use of AI-enabled tools.

🎯 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, Master’s degree preferred. • 20+ years of progressive experience in healthcare analytics, medical cost analytics, payment integrity, financial modeling, or related fields. • Strong analytical and technical skills, with hands-on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms). • Proven ability to translate complex analyses into actionable business insights, with clear, confident communication for senior and executive audiences. • Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs. • Comfort working in regulated and compliance-aware environments (claims operations, audit programs, policy, and related controls). • Strong collaboration and influence skills, with the ability to balance multiple priorities in a matrixed environment. • Self-starter with a strong orientation toward continuous improvement, ownership, and impact.

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities