Program Management Lead Analyst - Evernorth - Remote

Cigna Healthcare is dedicated to improving the health and vitality of those they serve. They are seeking a Program Management Lead Analyst to lead initiatives that enhance claim payment precision and reduce unnecessary medical spend, utilizing analytical expertise and strategic thinking.

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