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 Cigna’s 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 team’s 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.

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 98,200 - 163,600 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, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll 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,