Job Information
The Cigna Group Business Project Lead Analyst in Sacramento, California
Role Overview
The Business Project Lead Analyst supports the Special Investigations Unit (SIU) by providing critical operational, system, and workflow support for prepay edits, claim processing, and payment integrity controls. This role partners closely with SIU leadership, Payment Accuracy, and internal system teams to ensure SIU operational activities are executed accurately, timely, and in alignment with established protocols.
This position plays a key enablement role within SIU Operations , maintaining system integrity, workflow discipline, and control execution. This is not an investigator role.
Key Responsibilities
Submit, manage, and track TIN add and removal requests for prepayment edits to support appropriate claim intervention
Submit, monitor, and remove overpayment suppression requests based on defined case types and status changes
Create and submit flag requests for segments and Provider IDs (PIDs) associated with flagged TINs
Perform claims research and analysis to support protocol management, workflow validation, and issue resolution
Partner with the Protocol Manager (Fraud Manager) and Payment Accuracy teams to identify, troubleshoot, and resolve prepay edit and workflow issues
Research and coordinate provider update requests in accordance with established SIU processes
Support EFT setup and change requests , including outreach for approval/denial and submission of required documentation
Collaborate with internal partners to ensure timely execution of system updates and operational requests
Maintain ownership, accuracy, and documentation of assigned requests through completion
Support audit readiness by ensuring control execution, documentation, and request traceability within SIU workflows
Qualifications
Bachelor’s degree strongly preferred, or equivalent relevant work experience
3+ years of experience supporting prep ay edits and claim processing
Demonstrated experience working in a highly matrixed environment
Strong analytical, research, and problem-solving skills
Ability to manage multiple priorities and respond with appropriate urgency
Proficiency in Microsoft Office (Excel, Word, PowerPoint)
Excellent written and verbal communication skills
Strong organizational and time-management skills
Familiarity with audit findings, claim quality issues, and control-based operations 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 75,700 - 126,100 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.
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 (https://jobs.thecignagroup.com/us/en/benefits) .
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.