Job Overview
Location
United States Work at Home
Job Type
Full-time
Category
Data Science
Date Posted
June 18, 2026
Full Job Description
đź“‹ Description
- • Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across payment integrity programs including pre-payment and post-payment editing, clinical coding audits, and recovery.
- • Translate complex analytical findings into clear, executive-ready insights to inform the strategic roadmap for technical, operational, and senior leadership audiences.
- • Own financial impact assessments and business cases for payment integrity initiatives, including forecasting, variance analysis, and performance improvement recommendations.
- • Monitor and measure program performance through dashboards, scorecards, and executive reporting for pre-payment and post-payment editing, coding audits, and recovery initiatives.
- • Identify and size new savings opportunities by analyzing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive healthcare practices.
- • Partner cross-functionally with teams including Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, and Product to align analytics with enterprise decisions and execution.
- • Support vendor evaluation and sourcing through data-driven analysis that informs negotiation strategies, pricing structures, and performance guarantee terms.
- • Advance analytics capabilities by improving data quality, strengthening controls, and enabling scalable, self-service solutions through automation and the thoughtful application of AI-enabled tools such as predictive modeling and NLP.
- • Ensure all analytics and reporting activities comply with regulated healthcare environments, including claims operations, audit programs, and policy-related controls.
- • Deliver actionable business insights grounded in deep understanding of reimbursement methodologies including MS-DRG, APCs, HCPCs, and RBRVS, and familiarity with professional and facility claim constructs.
🎯 Requirements
- • 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
- • 8+ 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 SQL, Excel, SAS, Tableau, Databricks, or similar platforms
- • Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs
- • Proven ability to translate complex analyses into actionable business insights for senior and executive audiences
- • Comfort working in regulated and compliance-aware environments (claims operations, audit programs, policy, and related controls)
🏖️ Benefits
- • Annual bonus plan eligibility
- • Medical, vision, dental, and well-being and behavioral health programs starting on day one
- • 401(k) with company contributions
- • Company-paid life insurance
- • Tuition reimbursement
- • Minimum of 18 days of paid time off per year and paid holidays
Skills & Technologies
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About The Cigna Group
The Cigna Group is a global health services company formed in 1982 through the merger of Connecticut General and INA Corporation. It provides medical, dental, disability, life and accident insurance, pharmacy benefit management, and behavioral health services to employers, individuals and government entities. Headquartered in Bloomfield, Connecticut, the company operates in over 30 countries and jurisdictions, serving more than 180 million customer relationships worldwide through its subsidiaries and affiliates.
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