Business Analytics Lead

1 month ago

Irvine, California, United States The Cigna Group Full time

Role Summary

We are seeking a highly skilled and innovative professional to lead our Digital & Analytics team as a Provider Contract & Network Underwriting Lead Analyst. In this role, you will conduct in-depth analysis of hospital and professional provider contracts, partnering with Contracting to deliver unit cost results that align with trend and cost expectations. You will evaluate the impact of proposed terms on profitability, trend, and other key metrics. Additionally, you will collaborate with network management, medical management, and sales units to understand resulting medical expense results and improve future negotiation strategy.

Key Responsibilities

  • Analyze the impact of contract negotiations on trends and economic metrics for facility and professional contracts.
  • Utilize competitor data and insights in contract negotiation modeling to inform strategic decision-making.
  • Effectively influence contracting in a strategic fashion, offering meaningful options during negotiations with providers.
  • Provide ad-hoc analysis and deep dives into data to support negotiation and provide value to contracting partners.
  • Summarize and explain findings and recommendations to stakeholders.
  • Proactively identify opportunities for trend reduction and engage contracting to incorporate these into plan development.
  • Keep management informed of progress and proactively identify risks and opportunities for meeting plan results.
  • Collaborate with Provider Management Tool (PMT) Analysts to oversee corrections and updates to forecasting tools.
  • Work with matrix partners to validate and adopt AMP and NextGen modeling tools.

Requirements

  • 3+ years' industry experience solving business problems through the application of analytic approaches, particularly in analyzing medical claims experience in TMC and/or Contract Underwriting for Fee for Service and Fee for Value contracts.
  • Knowledge of standard medical coding: CPT, ICD10, HCPC ideal.
  • Proficiency with Excel to perform data mining and reporting functions; familiarity with Access is preferred.
  • Strong analytical and problem-solving skills with the ability to independently perform analyses and apply statistical models to validate/interpret results.
  • Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management.
  • Strong communication skills, including written, oral, and group presentation.
  • Ability to work independently while managing multiple tasks and meeting deadlines.
  • Bachelor's degree in Finance, Economics, Business, Health Policy Analysis, Healthcare Administration, Mathematics, or Statistics preferred.

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