Program Management Lead Analyst - Remote

Program Management Lead Analyst – Project Analyst

This role is within AAPS (Affordability & Accuracy Pre/Post Pay Solutions).  AAPS focuses on Accurate Claim Payment and Reducing Medical Cost expenditures at Cigna.

• The Program Management Lead Analyst (PA) assists in supporting the AAPS program through strategic policy/quality. They collaborate with the field and business partners in planning, organizing, and executing continuous improvement opportunities and financial risk management activities to improve claim accuracy outcomes and reduce overpayments.

The Program Management Lead Analyst fulfills the following duties:

• Uses subject matter expertise, analytical skills, networking with matrix partners/vendors to define overpayment scenarios and define edit rules which deliver acceptable false positive results and financial returns.
• Manages assigned edits, lifecycles and associated corrective actions.
• Analyzes weekly/monthly reporting to determine if their aligned edits/reports are performing efficiently.
• Provides comprehensive business cases for assigned edits/reports--includes root cause analysis, financial impact, claim volume impact, resource impact, expense of corrective actions, expense of errors, interim and long-term solutions with timelines.
• Analyzes variance as needed and defines/addresses cause (i.e., data issue).
• Trend edit performance to identify areas of opportunity which could include but is not limited to: False positive analysis, Quality analysis and Adjustment analysis
• Partners with the quality area as necessary to address quality trends and opportunities.
• Engages with matrix partners on any new edit/report implementation, edit enhancements or edit remediation.
• Performs data queries, data mining in response to needs for Pre-Pay Correction Program. 
• Documents information as required in the Intake Tracker.
• Consults with team as required to define requirements. Refines requirements as necessary. May participate in requirement sessions and perform testing of applications/databases.
• Trouble shoots, problem solves with technical experts as required.
• Works with extended Pre-Pay correction team, Business Intelligence to define requirements for support systems -- data mining, predictive modeling, QET, Tracking and Reporting databases, AA, and T4.
• Participates in projects to support business initiatives.
• Manages data projects.

Qualifications:

• Bachelor’s degree or higher strongly preferred or equivalent work experience required
• 5+ years of work experience in Medical Claim processing or project management required
• Strong system knowledge and claim processing background in one or more of the following Cigna claim systems required - Proclaim, PMHS, or Facets
• 3+ years of medical claims processing experience
• Ability to work collaboratively with a team of highly motivated individuals
• Demonstrated ability to work independently with little supervision
• Working experience with analytics and problem solving
• Proficiency in MS Office products
• Ability to recognize and respond to issues with the appropriate sense of urgency, escalating problems as appropriate
• Ability to work well with Vendor and internal departments
• Excellent communication skills to include written, oral and group presentation skills
• Strong time management skills
• Familiar with audit errors and claim quality issues

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 76,400 - 127,300 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.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

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.