ProFee Specialist

Cigna Health and Life Insurance Company; United States; Remote; USD 96,000 - 160,000; Full time

Job summary

An established industry player is seeking a motivated Provider Contract & Network Underwriting Advisor to join its dynamic Global Data & Analytics team. This role focuses on creating network solutions and provider contracts for the Northeast market. You'll leverage your analytical skills to evaluate financial models and impact on profitability while collaborating with various teams to enhance negotiation strategies. If you're passionate about healthcare and eager to make a difference, this opportunity offers a chance to thrive in a supportive environment with comprehensive benefits.

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

401(k) with Company Match

Paid Time Off

Wellness Programs

Qualifications

• 5+ years of experience in healthcare or managed care.
• Strong analytical and problem-solving skills required.

Responsibilities

• Influence contracting and negotiate effectively with providers.
• Manage planning processes for assigned markets independently.

Skills

Healthcare/Managed Care Experience

Physician Analytics

Analytical Skills

Problem-Solving Skills

Communication Skills

Data Mining

Medical Coding Standards

Tools

Microsoft Excel

Microsoft Access

SAS/SQL

Job description

Cigna is seeking a highly motivated and innovative team member to join our growing and dynamic Global Data & Analytics team as a Provider Contract & Network Underwriting Advisor for the Northeast Market's Team, concentrating on Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont providers. In this role, you will assist contractors in creating network solutions and provider contracts to ensure Cigna’s competitive position in the market. You will use financial models to evaluate the impact of proposed terms on profitability, trends, and other metrics. You will also partner with network management, medical management, and sales units to understand resulting medical expense results and improve future negotiation strategies.

Responsibilities

1. Effectively influence contracting strategically and offer meaningful options during negotiations with providers.
2. Manage the planning process for assigned markets independently and effectively, driving plans to meet overall corporate objectives.
3. Proactively identify opportunities for trend reduction and collaborate with contracting to incorporate these into plans where appropriate.
4. Work with PCD and Pro fee analysts to oversee corrections and updates to forecasting tools.
5. Provide ad hoc analysis and deep dives into data to support negotiations and add value to contracting partners.
6. Summarize and explain findings and recommendations clearly.
7. Mentor junior underwriters.

Qualifications

• 5+ years of experience in healthcare/managed care.
• Experience with physician analytics.
• Experience in TMC and/or Contract Underwriting is preferred.
• Strong analytical and problem-solving skills.
• Excellent written, oral, and group presentation communication skills.
• Understanding of managed care business processes, data, systems, and applications related to claims payment, enrollment, benefit design, and utilization management.
• Familiarity with data mining and reporting tools such as Microsoft Excel, Access, or SAS/SQL.
• Ability to work independently, manage multiple tasks, and meet deadlines.
• Experience with claim data and familiarity with medical coding standards like CPT, ICD-9, HCPCS.

Additional Information

If working remotely, internet connection must be via cable broadband or fiber optic with speeds of at least 10Mbps download and 5Mbps upload.

Anticipated annual salary ranges from $96,000 to $160,000, depending on experience and location, and may include participation in an annual bonus plan.

We offer comprehensive benefits supporting your health and well-being, including medical, vision, dental, wellness programs, 401(k) with company match, paid time off, and more. For details, visit Life at Cigna Group.

About The Cigna Group

We’re dedicated to improving health and vitality through our divisions Cigna Healthcare and Evernorth Health Services, committed to enhancing lives. Join us in driving growth and making a difference.

We are an equal opportunity employer and consider all qualified applicants without regard to race, color, age, disability, sex, sexual orientation, gender identity, veteran status, religion, national origin, or other protected characteristics.

If you require accommodation during the application process, please email: [e-mail].