Remote, Work from Home, United States
The Flexible Network Data Quality Analyst/Business Analytics Lead Analyst will support the Network Quality & Innovation organization and the associated functional processes within Provider Solutions & Operations. This position will conduct quality activities that measure and analyze the quality and consumption of provider data. Activities may include conducting focused audits, utilizing quality tools, analyzing root cause and performing analytical techniques. Along with these duties, this role improves the quality of the data, the process, and improvements in data consumption. The Business Analytics Lead Analyst will also identify defects and will contribute to pinpointing the causes and offer recommendations for prevention. This role will maintain a strong focus on facts and data 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.
+ Conducts audits as well as in-process manual and 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 and coaching to improve
+ Assesses the accuracy, completeness, and currency of Networks, Contracts, Demographic and Reimbursement data within Cigna systems
+ Organizes and completes activities including documented support of any audit findings and defects
+ 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 findings
+ Conducts data comparisons utilizing source information relative to demographic, contract and reimbursement data
+ 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.
+ Bachelor's Degree or higher strongly preferred or equivalent work experience required.
+ 3+ years of experience in data quality within a healthcare setting required.
+ Experience or exposure to audits or quality activities preferred.
+ Strong knowledge and exposure/experience in the healthcare operations claim process, with emphasis on healthcare providers, contracting, and provider services required.
+ Strong knowledge of Network, Contract and Demographic data elements required.
+ Strong knowledge of Provider structures and relationships required.
+ Strong knowledge of CPF preferred.
+ Experience with HCPM preferred with additional claim system experience a plus
+ Experience in analytical tools such as MS Excel (required) and MS Access (preferred)
+ Solid communication skills with the ability to discuss data analysis results
+ Organization skills with the ability to manage data sets
+ Adept critical thinking skills with the ability to determine causes with consistency in results
+ Proven ability to build strong partnerships and influence others
+ Excellent time management skills and ability to manage multiple priorities
This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.
This position is not eligible to be performed in Colorado.
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?
_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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response._