Business Analytics Lead Analyst - Work from home

Key Skills

Apache Hadoop, C Programming, C++, Data science techniques, Java Programming, Machine learning techniques, MapReduce, Python Programming, PyTorch, R Programming, Scala Programming, SQL, TensorFlow

Job Description

Remote, Work from Home, United States

Quality Outcomes

This role supports the Process Performance organization and the associated functional processes within Connected Care Provider Operations. This position will conduct quality audit activities that measure and analyze the quality and consumption of provider data along with partnering in process improvement initiatives.

Activities may include conducting focused audits, utilizing quality tools, analyzing root cause and performing analytical techniques. The Business Analytics Lead Analyst will also identify defects and will contribute to isolating the causes and offer recommendations for prevention. This role will maintain a strong focus on facts and data in order to understand the quality of our network, contracts, and demographics in Provider data.

The Business Analytics Lead Analyst should be proficient conducting sample audits, designing and maintaining audit procedures, implementing quality inspections, assisting in the development and enhancement of quality tools, and analyzing results to improve quality outcomes. This role uses various tools that assist with quality assessments producing metrics and information and requires a proficiency working with data and basic data analysis.

Duties include:

• Conducts audits that range from manual to semi-automated inspections for specific transactions utilizing data mining and intelligence tools
• Conducts independent and/or collaborative data analysis to improve the quality in Provider data for our customer, client, and provider experience of quality outcomes
• Works independently and collaboratively with Cigna business partners to verify and document quality defects with opportunities for improvement in existing processes
• Assesses the accuracy of Networks, Contracts, Demographic and Reimbursement data within Cigna systems
• Organizes and completes activities including documented support of any audit findings and defects along with offering suggestions for improving the process
• Ensures compliance with all internal and external quality audit requirements
• Implements and supports business activities utilizing data mining, reporting, and other intelligence methods and tools
• Committed to improving skills and competencies by demonstrating initiative and leadership in ongoing coaching and training programs
• Analyzes results for trends and root cause through comparative, diagnostic, or statistical analysis with conclusions
• Makes recommendations based on audit findings
• Conducts data comparisons utilizing source information relative to demographic, contract and reimbursement data from source systems
• Documents and maintains inventory of failures within the process as fed by audit and data obtainable through analysis and reporting related to claims, directory and system fallout, etc.
• Identifying technology advances and processes appropriate for automation

Qualifications:

• Bachelor's degree or higher strongly preferred or equivalent work experience
• Some knowledge or exposure to include some of the following: CPF, HCPM, Proclaim, PMHS, SANP, or Facets, etc.
• 3+ years of experience/preferred knowledge of Network, Contract and Demographic data elements
• Working knowledge of Tableau and/or SQL a plus
• Strong drive to learn new concepts/technology with the ability to embrace a rapidly changing environment
• Experience or exposure to audits or quality related activities
• Microsoft Excel proficient (including pivot tables, conditional formatting, vlookup, concatenating, etc. required)
• Organizational skills with the ability to manage large data sets
• Strong PowerPoint presentation skills with the ability to discuss data analysis results and root cause defects through storytelling to influence process improvements
• Adept critical thinking skills with the ability to identify process gaps and determine root causes with consistency in results
• Strong knowledge and exposure/experience in the healthcare operations claim process, with emphasis on healthcare providers, contracting, and provider services is a plus

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?