Program Management Sr. Analyst – Project Analyst Assistant - Cigna HealthCare - Remote

Cigna Healthcare is dedicated to improving health and vitality, and they are seeking a Program Management Senior Analyst to support the AAPS program. The role involves collaborating with Project Analysts to enhance claim accuracy outcomes and manage financial risk activities.

Responsibilities:

• Assists Project Analysts (PA’s) for the Pre-Pay Correction Program using subject matter expertise, analytical skills, networking with matrix partners/vendors to define overpayment scenarios and define edit rules which deliver acceptable false positive results and financial returns
• Supports the PA with management of assigned edits, lifecycles and associated corrective actions
• Assists Project Analysts in providing comprehensive business cases for assigned edits. This includes root cause analysis, financial impact, claim volume impact, resource impact, expense of corrective actions, expense of errors, interim and long term solutions with timelines
• Authors and maintains Prepay Knowledge Articles, ensuring compliance with Policy & Procedure guidelines
• Performs claim testing to validate edit query logic and confirm Knowledge Article clarity
• Assists Project Analysts on edit reviews and edit viability based on testing results
• Performs quality and false positive reviews to validate edits are running efficiently
• Develops and facilitates New Edit and Edit Refresher training
• Partners with matrix partners to develop, implement and maintain Prepay Reports
• Documents information as required in the Intake Tracker
• May perform data queries, data mining in response to needs for the Pre-Pay Correction Program
• Consults with team as required to define requirements
• Refines requirements as necessary
• May participate in requirement sessions and perform testing of applications/databases
• Trouble shoots, problem solves with technical experts as required
• Works with extended Pre-Pay correction team, Business Intelligence to define requirements for support of systems. This includes data mining, macro automations, tracking and reporting databases, AA, and T4
• Updates and maintains training and resource materials used in the Prepay and Post Pay programs
• Maintains the AAPS Training Recording library

Requirements:

• Bachelor's degree or higher strongly preferred or equivalent work experience required
• Must have strong system knowledge and claim processing background in one or more of the following Cigna claim systems (Proclaim, Facets or PMHS)
• 3+ years of claim processing experience required
• Ability to work well with vendor partners and internal departments
• Ability to work collaboratively with a team of highly motivated and diverse individuals
• Strong analytical and problem solving skills
• Proficiency in MS Office products
• Ability to react to issues with the appropriate sense of urgency
• Excellent communication skills to include written, oral and group presentation skills
• Strong time management skills
• Familiar with audit errors and claim quality issues