Cigna HealthcareRemote
Business Project Lead Analyst
United States of America
Full Time
1 week ago
$76,000 - $126,000 USD
H1B Sponsor Likely
Key skills
Prepay editsClaim processingMicrosoft OfficeAudit findingsClaim quality issuesControl-based operationsMatrixed environment experienceAnalytical skillsResearch skillsTime-management skillsCommunication
About this role
Cigna Healthcare is dedicated to improving health and vitality, and they are seeking a Business Project Lead Analyst to support the Special Investigations Unit (SIU). This role involves providing operational, system, and workflow support for prepay edits, claim processing, and payment integrity controls while ensuring timely execution of system updates and operational requests.
Responsibilities:
- Submit, manage, and track TIN add and removal requests for prepayment edits to support appropriate claim intervention
- Submit, monitor, and remove overpayment suppression requests based on defined case types and status changes
- Create and submit flag requests for segments and Provider IDs (PIDs) associated with flagged TINs
- Perform claims research and analysis to support protocol management, workflow validation, and issue resolution
- Partner with the Protocol Manager (Fraud Manager) and Payment Accuracy teams to identify, troubleshoot, and resolve prepay edit and workflow issues
- Research and coordinate provider update requests in accordance with established SIU processes
- Support EFT setup and change requests, including outreach for approval/denial and submission of required documentation
- Collaborate with internal partners to ensure timely execution of system updates and operational requests
- Maintain ownership, accuracy, and documentation of assigned requests through completion
- Support audit readiness by ensuring control execution, documentation, and request traceability within SIU workflows
Requirements:
- Bachelor's degree strongly preferred, or equivalent relevant work experience
- 3+ years of experience supporting prepay edits and claim processing
- Demonstrated experience working in a highly matrixed environment
- Strong analytical, research, and problem-solving skills
- Ability to manage multiple priorities and respond with appropriate urgency
- Proficiency in Microsoft Office (Excel, Word, PowerPoint)
- Excellent written and verbal communication skills
- Strong organizational and time-management skills
- Familiarity with audit findings, claim quality issues, and control-based operations