Medical Cost Analytics Senior Manager (Remote)

RiseMe; Tennessee; Hybrid; USD 131,000 - 218,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

Well-being programs

401(k)

Life insurance

Tuition reimbursement

Paid time off

Paid holidays

Leaves of absence

Job summary

The Cigna Group is seeking a Senior Manager for the Payment Integrity Analytics Team. You will lead analysts, shaping medical cost trends and affordability strategies with AI, data insights, and executive-facing communication.

You will work across finance, operations, clinical, product and network teams to ensure accurate financial measurement for new programs and initiatives, with a focus on improving affordability and customer experience at scale.

Qualifications

• Bachelor’s degree in a quantitative field; Master’s degree preferred.
• 7+ years of progressive experience in medical claims analytics and healthcare economics.
• Experience leading teams in a matrixed environment.
• Strong analytical and technical skills with SQL, Excel, SAS or similar tools.
• Knowledge of medical claim coding and provider reimbursement.

Responsibilities

• Lead strategic analytics identifying cost drivers, trends, risks and affordability opportunities.
• Develop analyses and AI to support enterprise Payment Integrity strategies.
• Translate findings into executive-ready insights for senior leadership.
• Own business cases including forecasts, variance analysis, and recommendations.
• Oversee analytics for initiatives, policy changes and performance monitoring.
• Improve reporting and self-service analytics using AI-enabled tools.

Skills

Data analytics

Executive communication

People leadership

SQL

Excel

SAS

Databricks

Tableau

Medical claims coding

Education

Bachelor’s degree in quantitative field

Master’s degree preferred

Tools

SQL

Excel

SAS

Databricks

Tableau

Job description

The Payment Integrity & Affordability Governance organization partners across the enterprise to deliver insights that help reduce healthcare costs, improve outcomes, and strengthen financial sustainability. Our work supports both internal and external partners by translating complex data into clear, actionable strategies.

The Payment Integrity Analytics Team focuses on measurement and analytics for national Payment Integrity programs—helping leaders understand the future strategy and current program performance including what’s working, where opportunities exist, and how we can continue to improve affordability and customer experience at scale.

About the Role

As a Senior Manager, you’ll lead a team of analysts supporting Payment Integrity initiatives. This role blends healthcare data analytics and AI, financial insight, and people leadership, with a strong emphasis on influencing decisions at the executive level. The role will also be responsible for comprehensively looking at the provider and payer landscape to identify and drive innovative approaches for understanding medical cost trends, provider behavior, provider billing behavior, and healthcare industry operations to streamline medical costs for health plan members.

This role will partner closely with stakeholders across finance, operations, clinical, product and network teams to evaluate trends, support proposals, and ensure accurate financial measurement for new programs and initiatives.

This is an ideal role for a leader who enjoys connecting strategy to execution—and who wants their work to directly impact healthcare affordability.

What You’ll Do

• Lead strategic analytics by identifying medical cost drivers and trends, risks, and affordability opportunities.
• Develop and execute analysis and AI to support Payment Integrity strategies at the enterprise level driving alignment across various business unites to ensure enterprise financial goals & priorities
• Tell the story behind the data, translating analytical findings into clear, executive-ready insights that influence decisions across technical, operational, and senior leadership audiences.
• Own financial business cases for new affordability initiatives, including forecasts, variance analysis, and recommendations to improve performance.
• Support Payment Integrity by overseeing analytics for initiatives, policy changes, and ongoing performance monitoring.
• Improve reporting and visualization by assessing current capabilities and advancing self-service analytics solutions, utilizing AI to optimize quality, accuracy and reporting (e.g., Databricks, Tableau, Claude, Cursor or similar tools).
• Modernize analytics through scalable methods, automation, and thoughtful use of AI-enabled tools where they add value.
• Monitors and conducts research of related affordability, AI, business trends, using data and qualitative performance measures, to advise senior management relative to Payment Integrity strategy.
• Manage and develop a team of analysts, setting clear priorities, ensuring high-quality output, and supporting continuous skill development.
• Balance multiple initiatives by prioritizing and delegating work effectively in a fast-paced, dynamic environment.
• Ensure data quality and accuracy by implementing appropriate checks, controls, and processes.
• Act as a trusted thought partner to senior leaders by proactively identifying insights, risks, and emerging trends that inform near- and long-term affordability strategy

What You’ll Bring

• Proven ability to translate complex analyses into actionable business insights.
• Clear, confident communication skills with experience presenting to senior and executive audiences.
• Demonstrated success managing multiple priorities and leading teams in a matrixed environment.
• A creative, critical thinker with strong attention to analytical accuracy.
• Comfortable working independently while collaborating closely with cross-functional partners.
• Self-starter with a strong orientation toward continuous improvement, ownership, and impact

Requirements

• Bachelor’s degree or equivalent in a quantitative field such as Economics, Finance, Data Science or Analytics, Business, Applied Mathematics, Public Health, Actuarial Science or similar. Master’s degree preferred
• 7+ years of progressive experience in medical claims predictive analytics, financial modeling, healthcare economics
• People Leader experience
• Strong analytical and technical skills, with hands-on experience using tools such as SQL, Excel, SAS, Databricks, Tableau, or similar platforms
• Experience with and knowledge of medical claim coding, and provider reimbursement

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 130,900 - 218,100 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, paid holidays, and leaves of absence.

• medical
• vision
• dental
• well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays
• leaves of absence

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 need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.