Remote, Work from Home, United States

Quality Outcomes Oversight

This role supports the Process Performance organization and the associated functional processes within Network Solutions & Operations. This position will conduct quality oversight activities that measure and analyze the quality and consumption of provider data along with partnering in process improvement initiatives.

Activities may include conducting focused audits, utilizing quality tools, analyzing root cause and performing analytical techniques. The Business Analytics Lead Analyst will also identify defects and will contribute to isolating the causes and offer recommendations for prevention. This role will maintain a strong focus on facts and data in order to understand the quality of our network, contracts, reimbursement, and demographics in Provider data.

The Business Analytics Lead Analyst should be proficient conducting sample audits, designing and maintaining audit procedures, implementing quality inspections, assisting in the development and enhancement of quality tools, and analyzing results to improve quality outcomes. This role uses various tools that assist with quality assessments producing metrics and information and requires a proficiency of working with data and basic data analysis.

Duties include:

• Responsible for identifying data abnormalities, isolating the issue, and performing additional analytics to determine root cause


• Maintain key partnerships with matrix partners across NS&O as well as offshore vendors


• Continuously innovating as well as helping to drive the execution of implementation of innovation initiatives within the team and organization


• Key contributor to developing the story of the data or issue to bring continued learning & change to NS&O processes


• Conducts audits that range from manual to semi-automated inspections for specific transactions utilizing data mining and intelligence tools


• Conducts independent and/or collaborative data analysis to improve the quality in Provider data for our customer, client, and provider experience of quality outcomes


• Works independently and collaboratively with Cigna business partners to verify and document defective data outcomes with opportunities for improvement in existing processes


• Organizes and completes activities including documented support of any audit findings and defects along with offering suggestions for improving the process


• Ensures compliance with all internal and external quality audit requirements


• Implements and supports business activities utilizing data mining, reporting, and other intelligence methods and tools


• Committed to improving skills and competencies by demonstrating initiative and leadership in ongoing coaching and training programs


• Analyzes results for trends and root cause through comparative, diagnostic, or statistical analysis with conclusions


• Makes recommendations based on findings to influence process improvements across the organization


• Documents and maintains inventory of failures within the process as fed by data obtainable through analysis and reporting related to claims, directory and system fallout, etc.


• Identifying technology advances and processes appropriate for automation

Qualifications - Required:

• Bachelor's Degree or higher strongly preferred or equivalent work experience required


• 3+ years of experience in a healthcare data environment


• Strong drive to learn new concepts/technology with the ability to embrace a rapidly changing environment


• Experience or exposure to audits or quality & data analytics related activities


• Microsoft Excel proficient required (pivot tables, conditional formatting, VLOOKUP, concatenating, etc.)


• Experience working in Access required


• Preferred knowledge of Network, Contract and Demographic data elements required


• Organizational skills with the ability to manage large data sets to find trends and patterns


• Strong PowerPoint skills with the ability to discuss data analysis results and root cause defects through storytelling to influence process improvements


• Adept critical thinking skills with the ability to identify process gaps and determine root causes with consistency in results

Preferred:

• Strong knowledge and exposure/experience in the healthcare operations claim process, with emphasis on healthcare providers, contracting, and provider services a plus


• Some knowledge or exposure to Cigna systems, which may include Proclaim, PMHS, SANP, or Facets


• Working knowledge of Tableau and/or SQL a plus


• Experience with SAS-EG a plus

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.