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The Cigna Group logo
The Cigna Group

At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers, and patients. Join us in driving growth and improving lives.

Business Project Lead Analyst

AnalystAnalystFull TimeRemoteSeniorTeam 10,001+Since 1982H1B No SponsorCompany SiteLinkedIn

Location

California + 1 moreAll locations: California | Connecticut

Posted

58 days ago

Salary

$75.7K - $126.1K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

Business Project Lead Analyst

The Cigna Group

• 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

Job 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 preferred

Benefits

  • medical, vision, dental, and well-being and behavioral health programs
  • 401(k)
  • company paid life insurance
  • tuition reimbursement
  • a minimum of 18 days of paid time off per year
  • paid holidays

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