Provider Contracting Lead Analyst – Voluntary O...
We are seeking a detail-oriented Lead Analyst to support the Voluntary Out-of-Network Protection Team. This role focuses on driving accurate, fair, and cost-effective pricing for voluntary out-of-network claims, with expertise in Maximum Reimbursable Charge (MRC), Fair Health pricing, and Medicare-based methodologies.
The Lead Analyst resolves pricing disputes, analyzes claims data, and develops tools and insights that support manual pricing teams and external pricing operations. This role directly impacts affordability for members, consistency for providers, and cost efficiency for clients.
Key Responsibilities
- Resolve voluntary out-of-network pricing disputes using MRC, Fair Health, and Medicare methodologies.
- Analyze pricing data to identify trends, variances, and improvement opportunities.
- Develop tools, reporting, and insights to support manual and external pricing operations.
- Collaborate with Claims, Call Center, and matrixed teams to improve pricing accuracy and workflows.
- Present clear, actionable findings to internal stakeholders.
- Ensure pricing strategies align with fair reimbursement and cost containment goals.
Required Qualifications
- 3–5 years of experience in healthcare analytics, provider pricing, or cost containment.
- Strong knowledge of MRC, Fair Health, and Medicare pricing.
- Advanced analytical skills with proficiency in Excel and reporting tools.
- Ability to manage multiple priorities independently in a production environment.
- Bachelor’s degree preferred or equivalent relevant experience.
Preferred Qualifications
- Experience with voluntary out-of-network claims and dispute resolution.
- Familiarity with manual pricing workflows and external pricing systems.
- Strong collaboration, communication, and problem-solving skills.
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 Cigna HealthcareCigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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: [email protected] for support. Do not email [email protected] 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.
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