Business Project Senior Analyst, MRC Manual Pricing - Cigna Healthcare - Remote

The Cigna Group is a leading healthcare company advocating for better health through every stage of life. This role plays a critical part in supporting non-participating cost containment efforts by ensuring accurate manual pricing decisions and collaborating with professionals to evaluate complex claims.

Responsibilities:

• Perform manual pricing for Maximum Reimbursable Charge (MRC1/MRC2) claims, ensuring accuracy, compliance, and alignment with pricing guidelines
• Analyze complex, sensitive, or escalated claims and recommend pricing outcomes that balance cost containment with customer experience
• Evaluate system and process challenges, identifying practical solutions that improve efficiency, accuracy, and overall results
• Provide clear analysis, pricing rationale, and guidance to internal and external partners requesting manual pricing support
• Take informed, decisive action on priority issues while managing multiple requests in a fast-paced environment
• Contribute to continuous improvement by sharing knowledge, strengthening functional expertise, and supporting team learning
• Support quality and accuracy initiatives that enhance appeal outcomes and improve member and provider experiences

Requirements:

• 3 years of experience in claims analysis, pricing, reimbursement, or related healthcare operations role
• Strong analytical and problem-solving skills, with the ability to assess complex data and make sound recommendations
• Experience working in fast-paced environments requiring prioritization, independent decision-making, and attention to detail
• Strong written and verbal communication skills, with the ability to explain pricing decisions clearly and professionally
• Proficiency with Microsoft Office tools, including Excel, Word, PowerPoint, and SharePoint
• Knowledge of healthcare claim payment methodologies and reimbursement practices
• Experience with claims systems such as Proclaim, PMHS, Facets, or SANP
• Experience supporting pricing strategy, appeals, or reimbursement analysis