About Us

Cigna Healthcare is a global health services and insurance company, that is dedicated to its mission of helping to connecting members, providers, and employers to deliver and manage healthcare coverage, cost, and care outcomes.

Job Description

The preauthorization, claims review, negotiation and care coordination analyst is responsible for managing the full continuum of care management and cost containment activities-from pre-service authorization through post -service claims review and provider negotiations. This role ensures clinical appropriateness, policy compliance, and cost effective care delivery while coordinating services for complex and high-risk members to improve outcomes and member experience.

Key Responsibilities

Preauthorization/Utilization Management:

• Review and process preauthorization request for medical services, procedures, and treatments
• Assess medical necessity using clinical guidelines, policy criteria, and regulatory requirements
• Collaborate with clinical teams to ensure appropriate level of care and service utilization
• Identify high-risk or high-cost cases early and route for care coordination or case management intervention
• Conduct detailed reviews of medical claims for accuracy, coding integrity, and benefit alignment
• Identify billing discrepancies, overutilization, and potential cost-saving opportunities
• Support appeals, reconsiderations and audit activities as needed
• Analyze trends in high-cost claims and recommend process improvements
• Lead or support negotiations for out-of-network claims, high-cost procedures, and single case assignments
• Partner with provider network and contracting teams to align negotiation approaches
• Document and track savings outcomes, including financial and operational impact
• Partner with case management, clinical teams, and providers to ensure continuity and quality of care

Qualification/Skills

• Degree or Diploma ; additional education in healthcare, business or related fields preferred
• Knowledge of medical claims adjudication, prior authorization processes, medical necessity review, and utilization management guidelines, with the ability to review clinical documentation and apply established coverage criteria.
• Coding certification (e.g., CPC, CCS) a plus but not preferred
• Excellent communication skills both written and oral, with a good telephone manner
• Flexibility and ability to multi-task.
• High level of accuracy and attention to detail.
• Problem solving & decision making.
• Team player
• Ability to interpret key data and identify trends.
• This role operates on a 24/7 schedule. Selected candidates will be assigned to one of the following shifts: 8:00 PM - 6:00 AM EAT (Sat-Wed), 9:00 PM - 7:00 AM EAT (Wed-Sun), or 7:00 AM - 3:00 PM EAT (Sat-Wed). Flexibility to work weekends and holidays is required.

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.

• Review and process preauthorization request for medical services, procedures, and treatments
• Assess medical necessity using clinical guidelines, policy criteria, and regulatory requirements
• Collaborate with clinical teams to ensure appropriate level of care and service utilization
• Identify high-risk or high-cost cases early and route for care coordination or case management intervention
• Conduct detailed reviews of medical claims for accuracy, coding integrity, and benefit alignment
• Identify billing discrepancies, overutilization, and potential cost-saving opportunities
• Support appeals, reconsiderations and audit activities as needed
• Analyze trends in high-cost claims and recommend process improvements
• Lead or support negotiations for out-of-network claims, high-cost procedures, and single case assignments
• Partner with provider network and contracting teams to align negotiation approaches
• Document and track savings outcomes, including financial and operational impact
• Partner with case management, clinical teams, and providers to ensure continuity and quality of care

• Knowledge of medical claims adjudication, prior authorization processes, medical necessity review, and utilization management guidelines
• Ability to review clinical documentation and apply established coverage criteria
• Excellent communication skills both written and oral, with a good telephone manner
• Flexibility and ability to multi-task
• High level of accuracy and attention to detail
• Problem solving & decision making
• Team player
• Ability to interpret key data and identify trends
• Coding certification (e.g., CPC, CCS) a plus but not preferred

• Degree or Diploma; additional education in healthcare, business or related fields preferred