Senior Medical Cost Analytics Advisor
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Job Description
Senior advisor optimizing medical cost analytics and payment integrity for Cigna’s health services. Building financial cases, measuring savings programs, and advancing automated analytics.
Responsibilities:
- Provide strategic and analytical support to the Payment Integrity team
- Evaluate pre-payment and post-payment programs, clinical coding audits, and recovery initiatives
- Identify opportunities for savings, improved performance, and enterprise affordability
- Translate data and program results into actionable insights and business cases
- Identify trends, risks, and affordability opportunities across cost containment and payment integrity programs
- Prepare clear, executive-ready insights for technical, operational, and senior leadership audiences
- Own financial impact assessments and business cases, including forecasts, variance analysis, and performance recommendations
- Monitor program performance through dashboards, scorecards, and executive materials
- Assess billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices
- Partner with Finance, Operations, Clinical, Network, Claims, Product, vendors, and other enterprise teams
- Support vendor evaluation and sourcing through analysis informing negotiations, pricing structures, and performance guarantees
- Improve data quality, strengthen controls, and enable scalable self-service analytics through automation and AI-enabled tools
Requirements:
- Bachelor’s degree 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
- Hands-on experience with SQL, Excel, SAS, Tableau, Databricks, or similar platforms
- Knowledge of reimbursement methodologies and coding, including MS-DRG, APCs, HCPCs, and RBRVS
- Familiarity with professional and facility claim constructs
- Experience in regulated and compliance-aware environments
- Experience modernizing analytics through automation and AI-enabled or advanced analytics methods, such as predictive modeling, NLP, or machine learning
- Ability to translate complex analyses into actionable business insights for senior and executive audiences
- Strong collaboration and influence skills in a matrixed environment
- Self-starter orientation toward continuous improvement, ownership, and impact
- Home internet through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload, if working at home
Benefits:
- Annual bonus plan eligibility
- Medical, vision, and dental benefits starting on day one
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
- Remote/work-at-home arrangement
- Cable broadband or fiber optic internet requirement for home working, with at least 10Mbps download/5Mbps upload
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