Intake Care Associate Analyst- Cigna Healthcare at Cigna

Job Description

Intake Care Associate Analyst : 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.

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