Business Project Lead Analyst

The Cigna Group

1d

About The Position

The Business Project Lead Analyst supports the Special Investigations Unit (SIU) by providing critical operational, system, and workflow support for prepay edits, claim processing, and payment integrity controls. This role partners closely with SIU leadership, Payment Accuracy, and internal system teams to ensure SIU operational activities are executed accurately, timely, and in alignment with established protocols.
This position plays a key enablement role within SIU Operations, maintaining system integrity, workflow discipline, and control execution. This is not an investigator role.

Requirements

• Bachelor’s degree strongly preferred, or equivalent relevant work experience
• 3+ years of experience supporting prepay edits and claim processing
• Demonstrated experience working in a highly matrixed environment
• Strong analytical, research, and problem-solving skills
• Ability to manage multiple priorities and respond with appropriate urgency
• Proficiency in Microsoft Office (Excel, Word, PowerPoint)
• Excellent written and verbal communication skills
• Strong organizational and time-management skills
• Familiarity with audit findings, claim quality issues, and control-based operations preferred
• 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.

Nice To Haves

• Familiarity with audit findings, claim quality issues, and control-based operations preferred

Responsibilities

• Submit, manage, and track TIN add and removal requests for prepayment edits to support appropriate claim intervention
• Submit, monitor, and remove overpayment suppression requests based on defined case types and status changes
• Create and submit flag requests for segments and Provider IDs (PIDs) associated with flagged TINs
• Perform claims research and analysis to support protocol management, workflow validation, and issue resolution
• Partner with the Protocol Manager (Fraud Manager) and Payment Accuracy teams to identify, troubleshoot, and resolve prepay edit and workflow issues
• Research and coordinate provider update requests in accordance with established SIU processes
• Support EFT setup and change requests, including outreach for approval/denial and submission of required documentation
• Collaborate with internal partners to ensure timely execution of system updates and operational requests
• Maintain ownership, accuracy, and documentation of assigned requests through completion
• Support audit readiness by ensuring control execution, documentation, and request traceability within SIU workflows

Benefits

• 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 and paid holidays.
• For more details on our employee benefits programs, click here.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level