Financial Engineering Senior Advisor - Provider Reimbursement

Key Skills

Data science techniques, Effective communication skills, Financial Risk, Leadership Skill, Planning and organization, Teamwork, US Healthcare Recruitment

Job Description

We are seeking a dynamic and creative healthcare professional to lead the financial engineering of our various provider facing solutions. This leader will work in tandem with the Network Strategy Solutions and Clinical organizations to drive the financial design of our programs, including our Value Based Care programs. The individual will be responsible for the modeling of financial outcomes for the Health Plan and the provider under various reimbursement arrangements. To accomplish this, the individual will be responsible for directing and leading the work of our analytics and other matrix partners. The role will have an opportunity to work closely with provider partners, including VillageMD and ENACO, to design financial reimbursement that is mutually beneficial to us and the provider. The individual will have exceptional communication skills, a demonstrated history of strong analytics skills, and a passion for developing new solutions.

Primary Responsibilities:

• Accountable business leader for developing new financial reimbursement methods, including, but not limited to, value based care

• Works in tandem with the VB design leads to ensure the reimbursement achieves both our financial and clinical goals

• Responsible for developing the financial provider engagement strategy and templates on how they can achieve financial goals

• Interface with the local markets and MEU teams to ensure our programs can be effectively negotiated and analyzed to maximize financial outcomes to the enterprise

• Reports to Managing Director Network Strategy & Solutions, with joint accountability to drive improved TCC through new and innovative reimbursement

• Responsible for directing various analytics resources across MEU and Data Science in support of our programs

• Works in close partnership with TCC measurement office to validate business cases on new initiatives

• Works in close partnership with Pricing to ensure new network solutions will drive improved competitiveness

• Oversees capability and solutions architecture & delivery of our reimbursement roadmap

• Work closely with IFP to ensure we have sufficient Financial engineering support as they expand their VB footprint to more risk based relationships

Leadership Responsibilities:

• Direct work in a matrix environment

• Build a high performing culture by continuously working with partners to add, develop and upgrade talent

• Develop strong talent pipeline and ensure effective succession planning is in place

• Drive best practices across markets as it relates to total medical cost value proposition

• Ensure appropriate structure / governance is in place to deliver on goals

• Build relationships with business leaders across functions and ensure functional / support teams are engaged as needed to support business strategy and execution priorities

Qualifications:

• 6+ years of experience with a successful track record of developing and leading teams / organizations in a similar capacity, management experience a plus

• Actuarial designation (FSA/ASA) or similar experience preferred

• Expert level knowledge of network design, Value Based Care, physician partnership, analytics, and product

• Strong working knowledge of how High Performing Providers can lead to differentiated pricing, service, benefits, or any other activities that benefit our clients and customers

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 126,900 - 211,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.