Program Management Lead Analyst - Cigna Healthcare - Remote

The Cigna Group

1d•Remote

About The Position

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.

Requirements

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 knowlege, 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.

Responsibilities

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.
Review 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, and 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.
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.