Program Management Lead Analyst - Evernorth - Remote

The Cigna Group is dedicated to improving healthcare affordability and accuracy through innovative solutions. The Program Management Lead Analyst will lead initiatives to enhance medical claim accuracy and reduce overpayments, utilizing analytical expertise and collaboration with internal and external teams.

Responsibilities:

• 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

Requirements:

• 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
• 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