IFP Business Analytics Advisor - ACA HHS Risk Adjustment

Profile Summary:

Individual & Family Plans (IFP) is a fast-paced Cigna Healthcare business unit serving the Affordable Care Act (ACA) market.

In this role within Evernorth, you will join the IFP Analytics team responsible for identifying and sizing new risk adjustment opportunities that not only create better health outcomes for patients but also enable Cigna Healthcare to remain compliant and competitive in the dynamic federally regulated Risk Adjustment space.

There's no shortage of deep dives and insights to be uncovered, and in this role, you'll have the agency to drive real, measurable change within the healthcare ecosystem.

If you're continually curious, eager to try new things, and passionate about making a difference for your peers, the organization, and the real people Cigna Healthcare has the privilege to serve, then this role is for you!

This role will primarily focus on analytics related to the large operational activities involved in prospective outreach (encouraging members to visit their doctor) and retrospective chart reviews.

This role will own, maintain, and continually enhance the targeting analytics inputs and outputs that our clinical business operations teams rely on.

Data is at the backbone of everything that this team does, and you will be viewed as a data and analytics expert.

Therefore, you have experience working with large databases and combining different healthcare data domains together using SQL.

Key Responsibilities:


* Own prospective outreach identification and impact evaluation - ensuring there is coordination between different business teams for the best patient outcome


* Own retrospective targeting selection and impact to determine which medical records Cigna Healthcare clinicians should review for accuracy


* Adapt quickly to changing business processes and new technologies (including clinical data integration and GenAI tech)


* Develop clear and thoughtful materials to communicate results/recommendations to varying levels of individuals and teams within the organization


* Navigate and lead initiatives effectively in a cross functional organization

Qualifications:


* Bachelor's Degree or higher in a quantitative field (e.g.

mathematics, statistics, data science, business, MIS, actuarial science, finance, etc.)


* Preferred MS/MPH in public health, statistics, economics, or related fields; or ASA/FSA


* 3-5 years of work experience in health insurance analytics or actuarial/finance analysis


* Strong familiarity with medical claims data


* Experience with ACA risk adjustment scoring algorithms and targeting models


* Strong database manipulation and SQL coding (or comparable programming experience) skills


* Ability to work with business partners in consultative manner


* Strong communication skills (e.g.

experience translating complex analyses into easy-to-follow slides/materials)


* Ability to independently prioritize and manage multiple resp...