Business Project Lead Analyst
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Job Location:
Bloomfield, CT - USA
Monthly Salary:
Not Disclosed
Posted on:
3 days ago
Vacancies:
1 Vacancy
Job Summary
Role Overview
The Business Project Lead Analyst supports the Special Investigations Unit (SIU) by providing critical operational system and workflow support for prepay edits claim processing and payment integrity controls. This role partners closely with SIU leadership Payment Accuracy and internal system teams to ensure SIU operational activities are executed accurately timely and in alignment with established protocols.
This position plays a key enablement role within SIU Operations maintaining system integrity workflow discipline and control execution. This is not an investigator role.
Key Responsibilities
- Submit manage and track TIN add and removal requests for prepayment edits to support appropriate claim intervention
- Submit monitor and remove overpayment suppression requests based on defined case types and status changes
- Create and submit flag requests for segments and Provider IDs (PIDs) associated with flagged TINs
- Perform claims research and analysis to support protocol management workflow validation and issue resolution
- Partner with the Protocol Manager (Fraud Manager) and Payment Accuracy teams to identify troubleshoot and resolve prepay edit and workflow issues
- Research and coordinate provider update requests in accordance with established SIU processes
- Support EFT setup and change requests including outreach for approval/denial and submission of required documentation
- Collaborate with internal partners to ensure timely execution of system updates and operational requests
- Maintain ownership accuracy and documentation of assigned requests through completion
- Support audit readiness by ensuring control execution documentation and request traceability within SIU workflows
Qualifications
- Bachelors degree strongly preferred or equivalent relevant work experience
- 3 years of experience supporting prepay edits and claim processing
- Demonstrated experience working in a highly matrixed environment
- Strong analytical research and problem-solving skills
- Ability to manage multiple priorities and respond with appropriate urgency
- Proficiency in Microsoft Office (Excel Word PowerPoint)
- Excellent written and verbal communication skills
- Strong organizational and time-management skills
- Familiarity with audit findings claim quality issues and control-based operations preferred
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.For this position we anticipate offering an annual salary of 75700 - 126100 USD / yearly depending on relevant factors including experience and geographic location.
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
Doing something meaningful starts with a simple decision a commitment to changing lives. At The Cigna Group were 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 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.
Required Experience:
Senior IC
About Company
Cigna Healthcare offers health insurance plans such as medical and dental to individuals and employers, international health insurance, and Medicare coverage.
