Payment Integrity Project Effectiveness Manager

4 weeks ago

Glasgow, United Kingdom The Cigna Group Full time

Payment Integrity Project Effectiveness Manager

The job profile for this position is Payment Integrity Project Effectiveness Manager, which is a Band 4 Management Career Track Role.

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Role Summary:

As the Payment Integrity Project Effectiveness Manager you will be directly supporting Cigna’s affordability commitment within Cigna International's business. This role is responsible for managing a team of project analysts, overseeing project initiatives impacting Payment Integrity and supporting the operational effectiveness of the Payment Integrity (PI) function. As an experienced Project Manager, and critical thinker, you will have significant experience articulating business complexity in the form of business processes and requirements and will be responsible for overseeing and contributing to project governance, outcomes, and ensuring decisions are documented, allowing for traceability and auditability. The role includes working across all International Healthcare Books of Business to ensure alignment and efficiencies within delivery, to raise risks, issues, perform analysis, track outcomes, and best practices. Working from home, he/she will work in partnership with the PI leadership team to optimise operational efficiency, project delivery and overall performance.

Responsibilities:

  • Support the Payment Integrity business strategy and responsible for executing departmental plans and priorities.
  • Responsible for oversighting various US Cost Containment initiatives being delivered through third parties including Enterprise and ensuring a pipeline of new activities to continue to enhance cost containment opportunities across all international books of business.
  • Accountable for maintaining an overview to inform through governance on the status and progress of PI affordability incremental initiatives. Support PI business owners with engagement with PMO to ensure timely delivery, the documentation of perceived risk and collation of mitigation actions. 
  • Accountable for overseeing the continued development of the HealthCloud solution bespoke for PI.
  • Responsible for owning the front-door change process for PI, ensuing business requests are reviewed, resourced and allocated.
  • For initiative impacting PI, ensuring all business acceptance testing is performed and approved to enable business improvement, adoption, implementation, and execution of processes.
  • Examines performance results for problem determination and takes appropriate corrective actions, reporting through appropriate governance.
  • Works cross-functionally within PI to improve the operational effectiveness of project and incremental initiative opportunities.

Skills and Requirements:

  • Proven track record of leading global and remote operational teams.
  • Ability to work in an Agile framework.
  • Knowledge of US healthcare delivery systems and provider business models, including competitor offerings on product, network, and payment integrity propositions would be a benefit.
  • Knowledge of US standard claims medical coding (CPT, ICD10, HCPC) and regulatory billing rules.
  • Demonstrated experience in seeking out, building and nurturing strong relations with third parties.
  • Exceptional stakeholder management and proven ability to develop strong working relationships within a fast-paced, matrix organization.
  • Superior problem solving, decision-making, project management skills.
  • Minimum of 5 years of health insurance or health care provider experience, and/or customer service or related experience.
  • Commercial experience operating effectively under pressure and delivering results.
  • Excellent communication skills, both written and verbal and high level of financial acumen.
  • Strong reporting and analytical skills with ability to create and improve reporting packs and methodologies.
  • Strong organization skills with the ability to balance multiple priorities at once and deliver on tight timelines.
  • Experience of operational risk management, including internal and external risk and compliance reporting.
  • Dedicated to meeting the expectations and requirements of internal and external customers, excellent at building effective relationships and gaining trust and respect.  
  • Flexibility to meet with global teams across varying time zones effectively.
  • Confidence to deal with internal stakeholders and ability to work across cross-functional teams.

About Cigna Healthcare

Cigna 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.

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