Business Analytics Advisor (Out of Network Analytics & Reporting) - Risk & Affordability - Evernorth

Cigna Healthcare is dedicated to improving the health and vitality of those they serve. The Business Analytics Advisor role involves conducting advanced analysis on out-of-network claims to enhance affordability and profitability, while collaborating with product, finance, and contracting teams.

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

Requirements:

• 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