Summary

This role will be accountable for the financial results and medical cost savings of Medicare Advantage payment integrity programs. Work with business partners to identify and implement new sources of savings. Maintain strong persistency and value within existing programs. Determine best practices and data sources to drive efficiency and consistency. Drive savings opportunity assessment and knowledge sharing. Engage with policy and operations teams to accurately assess financial impact of new clinical and reimbursement policies. This role will use analytics, trends and outcomes to continually identify savings opportunities and work with the business to implement plans to achieve business goals.

Responsibilities

• Focus on medical cost savings and analytics of pre/post payment claim editing, and auditing

• Regularly monitors results, efficiently addresses variance and implements corrective action

• Collaborates with Contracting, Coverage Policy Unit, Commercial Payment Integrity, Compliance, Network Analytics, Claim, and other business areas to accomplish goals

• This role is responsible for accurate reflection of current and projected savings from all pre/post payment claim editing, audit and claim recovery programs for MA

• This role is responsible for helping to establish incremental goals for the coming year and the achievement of those goals in partnership with the business

• This position partners with the Payment Integrity business area that has significant and direct bottom line impact where continued program growth, ramping program outcomes year over year and controlling wasteful and abusive billing patterns are expected deliverables

• This role includes partnering with the business and sourcing to provide analytics to successfully negotiate competitive deals and drive optimal outcomes

Qualifications

• 4+ years' of medical and financial experience in healthcare

• Proficient in use of SQL/SAS, Microsoft products and Tableau

• Significant experience in driving medical cost and affordability saving strategies

• Knowledge of various Medicare reimbursement methodologies such as MS-DRG, OPPS, IPPS, APR-DRG, and Fee Schedules, medical terminology, professional and facility coding, or billing analytics

• Knowledge and experience working with MA products, regulatory environment, claim management and audit programs, compliance requirements, practices and policies

• Skilled in complex medical and financial cost analysis, projections, variance analysis

• Comfortable and proficient in developing presentations and presenting to senior level executives on topics related to business area, responsibilities and competitive/industry standard information.

• Experience making independent, sound decisions in a fast paced environment

• Ability to collaborate and influence with audiences at various levels of the organization

• Ability to develop, interpret, confirm and summarize high level metrics

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 95,200 - 158,600 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.