Program Management Lead Analyst - Evernorth - Remote

Make a measurable impact on healthcare affordability and accuracy by leading initiatives that improve claim payment precision and reduce unnecessary medical spend. In this role, you will combine analytical expertise, collaboration, and strategic thinking to strengthen pre- and post-pay solutions that protect customers and the business alike.

Responsibilities

• Lead policy and quality improvement initiatives that enhance medical claim accuracy and reduce overpayments across pre- and post-pay programs.
• Partner with internal teams and external vendors to identify overpayment opportunities and design effective edit rules with balanced accuracy and financial outcomes.
• Own assigned edits throughout their lifecycle, monitoring performance, implementing corrective actions, and driving continuous improvement.
• Analyze weekly and monthly performance reports to assess effectiveness, identify trends, and recommend enhancements.
• Build clear, data-driven business cases that include root cause analysis, financial and operational impact, resource needs, and short- and long-term solutions.
• Investigate performance variances, including data quality issues, and address root causes in collaboration with technical partners.
• Monitor quality metrics, false positives, and adjustment trends to improve overall program performance.
• Collaborate closely with quality, business intelligence, and technology teams to implement new edits, enhance reporting, and resolve issues.
• Conduct data queries and mining to support pre-pay correction efforts and document work accurately in intake and tracking tools.
• Contribute to projects and data-related initiatives that advance enterprise affordability and accuracy goals.

Qualifications Required

• High School Diploma or G.E.D.
• 5+ years of experience in medical claims processing, program management, or a related analytical role.
• Strong knowledge of medical claim systems and workflows, with hands-on experience in at least one major claims platform.
• Demonstrated analytical, problem-solving, and data interpretation skills.
• Ability to work independently while collaborating effectively with cross-functional teams.
• Clear and confident written, verbal, and presentation communication skills.
• Proficiency with Microsoft Office tools and data analysis techniques.

Preferred

• Bachelor’s degree in a related field.
• Experience with audit findings, claim quality analysis, or payment integrity programs.
• Familiarity with data mining, predictive modeling, or business intelligence tools supporting claims accuracy.

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 77,500 - 129,100 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.

At The Cigna Group, 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), 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, click here.

About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. 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.

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. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.