Senior Medical Cost Analytics Advisor

🔥 14 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • 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

• 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, improved performance, and enterprise affordability • Translate data and program results into actionable insights and business cases • Identify trends, risks, and affordability opportunities across cost containment and payment integrity programs • Prepare clear, executive-ready insights for technical, operational, and senior leadership audiences • Own financial impact assessments and business cases, including forecasts, variance analysis, and performance recommendations • Monitor program performance through dashboards, scorecards, and executive materials • Assess billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices • Partner with Finance, Operations, Clinical, Network, Claims, Product, vendors, and other enterprise teams • Support vendor evaluation and sourcing through analysis informing negotiations, pricing structures, and performance guarantees • Improve data quality, strengthen controls, and enable scalable self-service analytics through automation and 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 • 8+ years of progressive experience in medical cost analytics, payment integrity, financial modeling, or related fields • Strong analytical and technical skills • Hands-on experience with 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 in regulated and compliance-aware environments • 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 for senior and executive audiences • Strong collaboration and influence skills in a matrixed environment • Self-starter orientation toward continuous improvement, ownership, and impact • Home internet through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload, if working at home

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • 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-at-home arrangement • Cable broadband or fiber optic internet requirement for home working, with at least 10Mbps download/5Mbps upload

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