Program Management Lead Analyst

Role Description

The role is part of AAPS (Affordability & Accuracy Pre/Post Pay Solutions), which aims to ensure accurate claim payments and reduce medical costs at Cigna. The Program Management Lead Analyst (PA) supports the AAPS program by focusing on policy and quality strategies. This position collaborates with field staff and business partners to plan, organize, and execute ongoing improvement initiatives and manage financial risks, ultimately enhancing claim accuracy and minimizing overpayments.

• Leveraging subject matter expertise and analytical skills to work with internal teams and vendors, identifying overpayment cases and developing edit rules that offer acceptable false positive rates and solid financial outcomes.
• Overseeing assigned edits throughout their lifecycle, implementing corrective actions as needed.
• Reviewing weekly and monthly reports to assess the effectiveness of aligned edits and reports.
• Preparing thorough business cases for assigned edits and reports, including:
  • Root cause analysis
  • Assessment of financial and operational impact
  • Resource considerations
  • Costs of corrective actions
  • Error expenses
  • Both interim and long-term solutions with timelines
• Investigating variances and addressing underlying causes, such as data issues.
• Monitoring edit performance trends to find opportunities for improvement, including analyzing false positives, quality metrics, and adjustments.

Additional duties:

• Collaborating with the quality team to address and act on quality trends and improvement opportunities.
• Engaging with various partners when implementing new edits/reports, making enhancements, or resolving issues.
• Conducting data queries and mining to support the Pre-Pay Correction Program.
• Recording necessary information in the Intake Tracker.
• Consulting with team members to define and refine requirements, participate in requirement sessions, and testing applications or databases as needed.
• Working with technical experts to troubleshoot and resolve problems.
• Coordinating with the broader Pre-Pay correction team and Business Intelligence to set requirements for support systems like data mining, predictive modeling, QET, tracking and reporting databases, AA, and T4.
• Taking part in projects to advance business goals.
• Managing data-related projects.

Qualifications

• Bachelor’s degree or higher strongly preferred or equivalent work experience required.
• 3+ years of medical claim processing required.
• 2+ years of strong claim systems and processing knowledge, particularly with one or more of the following platforms - Proclaim, Facets or PMHS required.
• Ability to collaborate effectively within a motivated team environment.
• Proven capability to work independently with minimal supervision.
• Demonstrated analytical and problem-solving experience.
• Proficiency in Microsoft Office applications (knowledge of pivot tables and VLOOKUP preferred).
• Ability to promptly recognize issues, respond appropriately, and escalate when necessary.
• Strong interpersonal skills for working with vendors and internal teams.
• Excellent written, verbal, and presentation communication abilities.
• Effective time management skills.
• Familiarity with audit errors and claim quality concerns.

Requirements

• 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.

Benefits

• Comprehensive range of benefits, with a focus on supporting your whole health.
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting on day one of your employment.
• 401(k) plan.
• Company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.
• Annual salary of 77,500 - 129,100 USD / yearly, depending on relevant factors, including experience and geographic location.
• Eligibility to participate in an annual bonus plan.

Company Description

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.