Business Analytics Senior Advisor Payment Integrity - Risk & Affordability ENCORE
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Senior Business Analytics Advisor, Payment Integrity – ENCORE PROGRAM As a Senior Advisor , you’ll provide strategy and analytical support for the Payment Integrity team inclusive of evaluating the current payment integrity programs, from pre-payment and post-payment editing, clinical coding audits, and recovery.
You will help translate the payment integrity program performance and results into actionable insights, business cases and identify new savings opportunities. In this role, you will and partner across finance, operations, clinical, network, claims, product and vendor teams to drive measurable progress toward enterprise affordability goals What You’ll Do: Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs.
Tell the story behind the data , translating complex findings into clear, executive-ready insights for technical, operational, and senior leadership audiences to short the strategic roadmap Own financial impact assessments and business cases for initiatives, including forecasts, variance analysis, and recommendations to improve performance.
Support program measurement and performance monitoring for pre-payment and post-payment editing, coding audits, and recovery programs across dashboards, scorecards, and executive materials. Identify and size new opportunities by assessing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices.
Partner across the enterprise (e.g., Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product) to align insights to decisions and execution. Support vendor evaluation and sourcing through data-driven analysis that informs negotiations, pricing structures, and performance guarantees.
Advance reporting and analytics by improving data quality, strengthening controls, and enabling scalable/self-service solutions through automation and thoughtful use of AI-enabled tools
Qualifications
- Bachelor’s degree in a quantitative field (e.g., Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, Applied Mathematics) or equivalent experience, Master’s degree preferred.
- Must be a Cigna retiree 20+ years of progressive experience in healthcare analytics, medical cost analytics, payment integrity, financial modeling, or related fields.
- Strong analytical and technical skills, with hands-on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms).
- Proven ability to translate complex analyses into actionable business insights, with clear, confident communication for senior and executive audiences.
- Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS ) and familiarity with professional and facility claim constructs.
- Comfort working in regulated and compliance-aware environments (claims operations, audit programs, policy, and related controls).
- Strong collaboration and influence skills, with the ability to balance multiple priorities in a matrixed environment.
- Self-starter with a strong orientation toward continuous improvement, ownership, and impact.
- 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.
- 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.
- If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.
- Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
- 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.