Supports the medical cost position of assigned markets through analysis of healthcare provider contracts, analysis of high performing network solutions, analysis of medical expense reports, data drill downs of trend drivers, and execution of key initiatives designed to address medical expense and product pricing trends. Partners with network management and pricing units to deliver medical expense results in line with trend/cost expectations to ensure strong competitive positioning within the marketplace.
ESSENTIAL FUNCTIONS
Provide analytical and strategic support of health care provider rate negotiations.
Identify opportunities for medical cost reduction, develop action plans, and drive execution.
Assess the cost and quality efficiency of health care providers.
Collaborate with local network team to develop and maintain high performing network solutions.
Assess competitiveness of standard and high performing network products.
Analyze reports and present findings to business partners at various levels of the organization.
Support business partners and team members on an ad hoc basis as needed to support various integral business needs.
Maintain strong communication with other analysts to identify new opportunities and share best practices.
Mentor/train business partners and other analysts.
QUALIFICATIONS
Bachelor's degree in Statistics, Mathematics, Economics, Health Policy Analysis, Finance, or other related field of study. Master's degree preferred.
5+ years of experience with health care data analysis required.
Experience with medical cost trend analysis and health care provider contract analysis preferred.
Strong analytical and problem solving skills with a proven track record of success.
Ability to independently perform data analysis while managing multiple projects and meeting strict deadlines.
Strong ability to validate and interpret results.
Ability to influence and drive strategic planning, action plan development, and execution of plans through engagement of business partners, education on key drivers and actionable levers, and thorough understanding of market-level dynamics.
Strong communication skills to include written, oral, and group presentation.
Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management.
Technical sophistication with various data mining and business intelligence tools such as SAS, SQL, Microsoft Access, or similar products, advanced Microsoft Excel skills.
Knowledge of standard medical coding including CPT-IV, ICD-10, DRG, revenue codes, and HCPCS.
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.
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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.