ProFee Specialist

The job profile for this position is Business Analytics Advisor, which is a Band 4 Senior Contributor Career Track Role.


* 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, specializing in physician analytics and special projects.

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


* Qualifications



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


* Strong analytical and technical skills


* Experience with Physician analytics


* Actuarial experience preferred


* Experience in TMC and/or Contract Underwriting preferred


* 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


* Must be nimble and able to manage multiple tasks and projects


* 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.

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, includ...