ProFee Specialist

Summary

Cigna is seeking a highly motivated and innovative team member to join our growing and dynamic Global Data & Analytics team as a Provider Contract & Network Underwriting Advisor for the Northeast Market's Team, concentrating on Maine, Massachusetts, New Hampshire, Rhode Island and Vermont providers.

In this role, you will assist contractors in creating network solutions and provider contracts to ensure Cigna's competitive position in the market.

You will use financial models to evaluate the impact of proposed terms on profitability, trend and other metrics.

You will also partner with network management, medical management, and sales units to understand resulting medical expense results and improve future negotiation strategy.

Responsibilities


* Effectively influence contracting in a strategic fashion and offer meaningful options during negotiations with a provider


* Independently and effectively manage the planning process for assigned markets and drive the plan to meet overall corporate planning objectives


* Proactively identify opportunities for trend reduction and engage contracting to build these into plan where appropriate


* Work with PCD and Pro fee analysts to oversee corrections and update to forecasting tools


* Provide ad hoc analysis and deep dives into data as appropriate to support negotiation and provide value to our contracting partners


* Summarize and explain findings and recommendations


* Mentors Jr UWs

Qualifications


* 5+ years of experience in health care/managed care work experience


* Expereince with Physican analytics


* Experience in TMC and/or Contract Underwriting preferred


* Strong analytical and problem solving skills


* Strong communication skills to include written, oral and group presentation


* Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management


* Familiarity various data mining and reporting tools, such as Microsoft Excel skills Microsoft Access, or SAS/SQL language


* Ability to work independently while managing multiple tasks and meeting deadlines


* Experience working with claim data and familiarity with standard medical coding: CPT, ICD9, HCPC preferred

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 96,000 - 160,000 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.

We want you to be healthy, balanced, and feel secure.

That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

Starting on day one of your employment, yo...