Senior Medical Cost Analytics Advisor (Remote)

Cigna Health and Life Insurance Company; Texas; Híbrido; USD 113.000 - 188.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health benefits

401(k)

Paid time off

Descripción de la vacante

The Cigna Group seeks a Senior Advisor to provide strategic, data-driven support to the Payment Integrity team. You will evaluate pre- and post-payment programs, coding audits, and recovery initiatives to drive savings and performance improvements.

Partner with Finance, Operations, Clinical, Network, Claims, Product, and vendors to advance affordability. You will translate complex analyses into executive-ready insights, own financial impact assessments, and shape strategic roadmaps with

Formación

• Bachelor’s degree or 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, with hands-on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms)
• Experience modernizing analytics through automation and AI-enabled and advanced analytics methods (e.g., predictive modeling, NLP, machine learning) where value is added
• If you work from home, reliable high-speed internet connection required (10Mbps down / 5Mbps up)
• For this position, annual salary range is 112,800 - 188,000 USD/year; eligible for annual bonus program
• The Cigna Group provides comprehensive benefits including health-related programs, 401(k), life insurance, tuition reimbursement, 18+ days PTO
• These benefits reflect a healthy, inclusive approach to employee well-being

Responsabilidades

• Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs
• Translate complex findings into executive-ready insights to inform strategic roadmaps
• Own financial impact assessments and business cases, including forecasts and variance analyses
• Support program measurement and performance monitoring across dashboards and executive materials
• Identify and size new opportunities by evaluating billing, coding, and reimbursement dynamics
• Collaborate across Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Product
• Assist vendor evaluation and data-driven negotiations and performance guarantees
• Advance reporting and analytics by improving data quality and enabling scalable self-service through automation and AI tools

Conocimientos

Data analytics

Executive communication

Strategic thinking

Cross-functional collaboration

Educación

Bachelor’s degree in quantitative field or equivalent

Herramientas

SQL

Excel

SAS

Tableau

Databricks

Descripción del empleo

As a Senior Advisor, you will provide strategic and analytical support to the Payment Integrity team, evaluating pre- and post-payment programs, clinical coding audits, and recovery initiatives to identify opportunities for savings and improved performance. You will turn data and program results into actionable insights and business cases while partnering across Finance, Operations, Clinical, Network, Claims, Product, and vendor teams to advance enterprise affordability goals.

What You’ll Do

• 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.

What You’ll Bring

• 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.

Requirements

• Bachelor’s degree or 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, with hands‑on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms).
• Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs.
• Experience modernizing analytics through automation and thoughtful use of AI-enabled and advanced analytics methods (e.g., predictive modeling, NLP, machine learning) where they add measurable value.
• 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 112,800 - 188,000 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.

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.

EEO & Diversity Statement

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.

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.

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.