Medical Advisor

• Provide strategy and analytical support for the Payment Integrity team.
• Evaluate pre-payment and post-payment editing, clinical coding audits, and recovery programs.
• Translate payment integrity program performance and results into actionable insights and business cases.
• Identify and size new savings opportunities.
• Identify trends, risks, and affordability opportunities across cost containment and payment integrity programs.
• Translate complex findings into executive-ready insights and support the strategic roadmap.
• Own financial impact assessments and business cases, including forecasts, variance analysis, and performance recommendations.
• Support program measurement and performance monitoring through dashboards, scorecards, and executive materials.
• Assess billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices.
• Partner across finance, operations, clinical, network, claims, product, vendor, contracting, coverage policy, compliance, reserving, and analytics teams.
• Support vendor evaluation and sourcing through analysis of negotiations, pricing structures, and performance guarantees.
• Improve data quality, strengthen controls, and enable scalable self-service analytics through automation and AI-enabled tools.

Senior advisor optimizing medical payment integrity analytics at The Cigna Group

Senior Medical Cost Analytics Advisor

Senior advisor optimizing medical payment integrity analytics for The Cigna Group, a health services company.
Assessing savings opportunities, financial impacts, coding, reimbursement, vendors, and advanced analytics.

• Provide scientific and medical leadership for gastroenterology therapeutic area of responsibility to internal and external stakeholders.
• Collaborate with Business Development to secure new business opportunities and expand market presence.
• Serve as a scientific advisor to sponsors regarding imaging strategy and implementation within clinical trials.
• Support study teams and internal departments through expert guidance on trial design, image review methodologies, and quality control practices.
• Identify and implement innovative tools, technologies, and process improvements to enhance operational effectiveness.
• Partner with cross-functional teams to align technology enhancements and service offerings with organizational objectives.
• Ensure scientific accuracy, quality, compliance, and integrity across project deliverables.
• Support development and review of imaging charters, imaging manuals, review rules, study reports, and other technical documentation.
• Gather and document scientific and business requirements from clients and internal stakeholders.

Senior Principal Scientific Affairs Advisor leading Medical Imaging initiatives

Senior Principal Scientific Affairs Advisor – General Medicine, Medical Imaging

Senior Principal Scientific Affairs Advisor leading scientific and operational initiatives in Medical Imaging for clinical trials. Collaborating with teams to ensure scientific excellence and regulatory compliance.

• Leverages scientific knowledge to support biological or biochemical research agendas
• Applies specific functional knowledge and working and general industry knowledge
• Develops or contributes to solutions to a variety of problems of moderate scope and complexity
• Works independently with some guidance, and reviews or guides activities of junior employees

Programmatic & Technical Advisor supporting biological or biochemical research agendas

Medical Countermeasure Development Advisor

Programmatic & Technical Advisor leveraging scientific knowledge to support research agendas and contributing to solutions. Requires experience in biological or chemical sciences and related fields.

Medical Advisor jobs in United States

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Senior Medical Cost Analytics Advisor

Senior Principal Scientific Affairs Advisor – General Medicine, Medical Imaging

Medical Countermeasure Development Advisor