Evernorth Health Services, a division of The Cigna Group, is hiring a Program Management Lead Analyst. In this remote role, you will make a measurable impact on healthcare affordability and accuracy by leading initiatives that improve claim payment precision and reduce unnecessary medical spend. You will combine analytical expertise, collaboration, and strategic thinking to strengthen pre- and post-pay solutions that protect customers and the business.
What You'll Do
- Lead policy and quality improvement initiatives that enhance medical claim accuracy and reduce overpayments across pre- and post-pay programs.
- Partner with internal teams and external vendors to identify overpayment opportunities and design effective edit rules with balanced accuracy and financial outcomes.
- Own assigned edits throughout their lifecycle, monitoring performance, implementing corrective actions, and driving continuous improvement.
- Analyze weekly and monthly performance reports to assess effectiveness, identify trends, and recommend enhancements.
- Build clear, data-driven business cases that include root cause analysis, financial and operational impact, resource needs, and short- and long-term solutions.
- Investigate performance variances, including data quality issues, and address root causes in collaboration with technical partners.
- Monitor quality metrics, false positives, and adjustment trends to improve overall program performance.
- Collaborate closely with quality, business intelligence, and technology teams to implement new edits, enhance reporting, and resolve issues.
- Conduct data queries and mining to support pre-pay correction efforts and document work accurately in intake and tracking tools.
- Contribute to projects and data-related initiatives that advance enterprise affordability and accuracy goals.
What We're Looking For
- High School Diploma or G.E.D.
- 5+ years of experience in medical claims processing, program management, or a related analytical role.
- Strong knowledge of medical claim systems and workflows, with hands-on experience in at least one major claims platform.
- Demonstrated analytical, problem-solving, and data interpretation skills.
- Ability to work independently while collaborating effectively with cross-functional teams.
- Clear and confident written, verbal, and presentation communication skills.
- Proficiency with Microsoft Office tools and data analysis techniques.
Nice to Have
- Bachelor’s degree in a related field.
- Experience with audit findings, claim quality analysis, or payment integrity programs.
- Familiarity with data mining, predictive modeling, or business intelligence tools supporting claims accuracy.
Technical Stack
- Microsoft Office
- Data mining tools
- Predictive modeling tools
- Business intelligence tools
Benefits & Compensation
- Salary: $77,500 - $129,100 USD per year
- Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
- 401(k).
- Company paid life insurance.
- Tuition reimbursement.
- Minimum of 18 days of paid time off per year.
- Paid holidays.
- Eligibility to participate in an annual bonus plan.
Work Mode
This is a fully remote position.
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.
