Business Analytics Advisor (Out of Network Analytics & Reporting) Risk & Affordability Evernorth

Out of Network Analytics Team: Our team responsibility is to perform valuable medical cost analysis on Cignas out of network (OON) protection programs and deliver actionable insights and reporting on cost containment initiatives. We specialize in OON provider analysis protection program earnings financial projections and reporting. This roles partners with product finance and the contracting teams on client OON benefit strategy analysis and reporting and assists with OON claim pricing techniques and local market OON reporting.

As a Business Analytics Advisor your role involves producing insights on out-of-network (OON) claims to help improve affordability. You are responsible for performing advanced analysis that connect the factors influencing results to their financial implications. Through your work you will gain expertise in market dynamics affecting OON affordability and create analyses that tie these drivers to both affordability and profitability targets. Additionally you will monitor progress toward affordability goals.

Responsibilities

• Conduct advanced financial and market analysis derive actionable insights to support OON Protection Program with a focus on surprise bill claims and the No Surprises Act in particular. Monitor cost trends and risks.
• Develop and refine financial models that highlight levers with their respective risks and opportunities to financial results.
• Identify and lead analysis projects that drive improved OON affordability for surprise bill claims and voluntary out of network claims.
• Work with network contracting to inform contracting strategy as it relates to OON providers and augment our set of self-service tools.
• Develop a data quality program that governs our OON analysis data set. Conduct regular audits to identify data issues and inconsistencies on our foundational data repository.
• Refine and enhance affordability tracking including operational financial and vendor reporting and processes while standardizing our teams approach to measuring affordability savings and earnings.
• Prioritize affordability needs and senior leaders reporting requests to understand our cost of care efforts.
• Oversee periodic reserve data studies using financial acumen while allowing for fine tuning and sensitivity analysis.
• Support occasional compliance audits and legal projects.

Qualifications

• Strong analytical and problem-solving capabilities; detail-oriented and effective in collaborating and communicating analytical findings with internal stakeholders.
• Proven ability to model financial impacts using repeatable and well documented processes. Able to identify and include the most important variables in modeling.
• Self-starter; highly motivated to grow continuously improve and develop subject matter expertise in Out-of-Network (OON) analytics and industry levers impacting results.
• Proficiency querying data using tools such as SAS and SQL with demonstrated commitment to continuous technical growth.
• Demonstrated ability to support cross-functional team initiatives and manage complex projects.
• Deep understanding of medical pricing provider contracting and affordability strategy.
• Strong informing and stakeholder engagement skills.
• Excellent communication and reporting skills with the ability to translate complex topics into clear actionable insights for various audiences.
• Five years of experience in the healthcare domain with foundational expertise in working with healthcare claims data.

Candidates who reside within 50 miles of Bloomfield CT or Plano TX may be asked to work a hybrid in office/work from home flexible arrangement.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group youll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment youll 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.

About The Cigna Group

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 require reasonable accommodation in completing the online application process please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

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.