Cigna Utilization Review Remote Jobs in Spring Hill, FL

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value.

You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com.

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

This position is eligible for remote work, but regular business travel will be required, including Avalon's corporate office located in Tampa, Florida.

About the Reporting Business Analyst position:

The Reporting Business Analyst serves as a critical bridge between business stakeholders, clinical operations, and data engineering teams to deliver actionable insights and reporting solutions that drive lab benefit management and healthcare performance improvement. This role focuses on translating complex business needs into technical requirements, designing and validating data models, and developing high-quality reports and dashboards in Tableau using data housed in Snowflake.

The ideal candidate combines strong analytical and communication skills with an understanding of healthcare or laboratory data. Responsibilities include gathering and documenting business and reporting requirements, performing data validation and quality checks, identifying utilization and operational trends, and supporting ongoing enhancements to analytic and reporting frameworks.

This position requires a strong understanding of SQL and database structures (preferably Snowflake), experience with Tableau development and visualization best practices, and familiarity with the SDLC and Agile tools such as JIRA/JQL. The Reporting Analyst must be able to interpret business challenges, recommend data-driven solutions, and communicate insights effectively across both technical and non-technical audiences.

This position is eligible for remote work, but regular business travel will be required, including Avalon's corporate office located in Tampa, Florida.

Reporting Business Analyst – Essential Functions and Responsibilities:

• Collaborate with business, clinical, and IT teams to gather, define, and document business and technical requirements for analytics, reporting, and data integration initiatives.
• Translate stakeholders into detailed functional specifications, source-to-target data mappings, and process documentation.
• Design, develop, and maintain Tableau dashboards and reports that deliver actionable insights into lab utilization, provider patterns, and operational performance.
• Perform data validation, root cause analysis, and reconciliation to ensure the accuracy and integrity of data used in reporting and analysis.
• Present findings, metrics, and recommendations through clear visualizations, written summaries, and stakeholder presentations.
• Support ongoing enhancements to data models, pipelines, and reporting frameworks within Snowflake to improve scalability and performance.
• Collaborate with medical policy, clinical operations, and analytics teams to measure the impact of policy changes and identify areas for improvement.
• Act as a liaison between technical developers and business users to ensure alignment on data definitions, logic, and report outputs.
• Facilitate requirements sessions, data review meetings, and cross-functional workgroups to support timely project delivery.
• Maintain compliance with HIPAA and other healthcare data privacy and security standards.
• Stay current with advancements in healthcare analytics, data visualization best practices, and Snowflake/Tableau technologies.
• Continuously evaluate and recommend process, system, and reporting enhancements to improve the efficiency and effectiveness of data-driven programs.

Reporting Business Analyst – Minimum Qualifications:

• 7 – 10 years as a business or operations analyst working in a health plan IT or operational environment.
• Undergraduate degree in Data Analytics, Information Systems, Computer Science, Health Informatics, Public Health, or a related field. Equivalent experience in healthcare data analysis, reporting, or business intelligence may be considered in lieu of a formal degree
• Experience working with healthcare data in a data warehousing or analytics environment, preferably leveraging Snowflake and Tableau.
• Background in Utilization Management (UM), medical management systems, or prior authorization workflows.
• Understanding of Medicare, Medicaid, and commercial insurance programs, including variations in coverage types (Group, Individual, ASO/Fully Insured, HMO/PPO).
• Proven experience facilitating stakeholder and client meetings to gather, validate, and prioritize reporting and data requirements.
• Demonstrated ability to document business and technical requirements, and collaborate with developers or data engineers to translate them into system or reporting functionality.
• Hands-on experience with data validation, QA/testing, and troubleshooting within analytic or reporting pipelines.
• Familiarity with Agile methodologies, SDLC processes, and tools such as JIRA and Confluence.
• Knowledge of or experience with clinical or laboratory data (e.g., HL7, EMR/EHR, lab result feeds) is highly desirable.
• Strong proficiency in SQL and understanding of database structures, joins, and performance optimization.
• Exposure to complementary technologies such as AWS, Python, dbt, Git, or data visualization best practices is a plus.
• Excellent communication skills with the ability to translate complex data findings into clear, actionable business insights.

Reporting Business Analyst – Preferred Qualifications:

• SAFe certification or experience working in a scaled Agile environment is a plus