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Support the total medical cost position of assigned markets through analysis/development of high level medical expense reports, detailed data drill downs of trend drivers, and execution of identified key initiatives designed to address medical expense trend. Partner with network management and medical management to deliver medical expense results in line with trend/cost expectations to ensure competitive positioning within the marketplace.
Monthly/Quarterly production of key medical expense reports for assigned local, regional and national markets
Understanding and presenting medical cost results to key matrix partners at various levels of the organization.
Delivering drill-down analytics in a pro-active and timely manner based on emerging results.
Communicating identified initiatives to matrix partners of assigned markets
Maintain current tracking of market initiatives and follow through on implementation
Maintain strong communication with other TMC analysts to identify new opportunities and best practices
5+ experience in health care/managed care with direct responsibility for medical cost and trend analysis.
Experience in TMC and/or Contract Underwriting preferred.
Strong analytical and problem solving skills
Strong SQL skills and technical sophistication with various data mining and business intelligence tools
Can independently perform analyses and apply statistical models to validate / interpret results
Ability to influence and drive strategic planning, medical action plan development, and execution of plans through engagement of matrix partners
Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management.
Knowledge of standard medical coding: CPT, ICD10, HCPCS, Rev Code
Qualified applicants will be considered without regard to race, color, age, disability, sex (including pregnancy), childbirth 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 an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.