Medical Advisor

• Provide strategic and analytical support to the Payment Integrity team
• Evaluate pre-payment and post-payment programs, clinical coding audits, and recovery initiatives
• Identify opportunities for savings and improved performance
• Translate data and program results into actionable insights and business cases
• Partner with Finance, Operations, Clinical, Network, Claims, Product, vendor, Contracting, Coverage Policy, Compliance, Network Analytics, Reserving, and Commercial Payment Integrity teams
• Identify trends, risks, affordability opportunities, billing patterns, coding and reimbursement dynamics, and wasteful or abusive practices
• Own financial impact assessments and business cases, including forecasts, variance analysis, and performance recommendations
• Support measurement and performance monitoring through dashboards, scorecards, and executive materials
• Identify and size new medical cost analytics opportunities
• Support vendor evaluation and sourcing through analysis of negotiations, pricing structures, and performance guarantees
• Improve data quality, strengthen controls, and enable scalable self-service reporting through automation and AI-enabled tools
• Develop executive-ready insights for technical, operational, and senior leadership audiences

Explore Senior Medical Cost Analytics Advisor at The Cigna Group. Review requirements and application details.

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