The Cigna Group

Bilingual

• Analyze information gathered by investigation/audit and report findings and prepare written summary/recommendations
• Prepare evidence package for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies
• Support on-site inspections and patient/provider interviews as necessary
• Respond to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance.
• May represent company as a witness in judicial proceedings when appropriate
• Prepare reports to expedite tracking and reporting of investigations

Bilingual Junior Healthcare Fraud Investigator

Vice President

• Own account management performance, driving persistency, growth, and earnings across the market.
• Develop and execute strategic plans that improve client retention and expand product solutions.
• Lead and coach client management teams to deliver strong day-to-day execution and long-term results.
• Monitor key metrics and dashboards to identify trends, risks, and opportunities for improvement.
• Strengthen market reputation through consultative engagement and value-driven client solutions.
• Partner with underwriting and cross-functional teams to optimize financial outcomes and client strategies.
• Drive renewal, retention, and bid prevention strategies to sustain long-term client relationships.
• Build and maintain strong producer and industry relationships to support business growth.
• Lead talent strategy by coaching leaders, developing successors, and building a strong pipeline of talent.

VP, Client Management – U500

Analyst

• Deliver accurate and complete data for client deliverables
• Ensure timely delivery of data in line with agreed schedules
• Perform initial root cause and quality control analyses to identify and assess issues
• Develop and maintain ongoing data surveillance processes
• Support new client onboarding by defining data delivery formats and schedules
• Establish appropriate data delivery methods
• Collaborate with internal teams on non-PHI data approvals
• Partner with clients to ensure successful test data sharing
• Build and maintain Databricks dashboards to support client needs
• Troubleshoot data delivery issues and coordinate resolves
• Provide release notes to internal teams
• Identify and implement process optimizations
• Support quarterly product releases and adapt to new data structures

Lead Analyst

Financial Planning and Analysis

• Support sourcing, evaluation and execution of limited partnership fund commitments and direct co-investment opportunities to generate attractive risk-adjusted returns.
• Assist in underwriting by analyzing fund strategies, track records, market dynamics, and risk considerations.
• Prepare clear, well-supported investment reports and presentations.
• Contribute to negotiations by reviewing legal documents and coordinating with both internal and external business partners.
• Monitor existing fund performance and maintain active dialogue with general partners.
• Research private equity market trends and share insights that inform decision-making.
• Assist with financial reporting, quarterly updates, and periodic portfolio reviews.

Alternative Investments Analyst

Director

• Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).
• May lead a team with direct reports.
• Point person for complex projects related to contracting strategy in the market.
• Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy.
• Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.
• Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
• Contributes to the development of alternative network initiatives.
• Supports and provides direction to develop network analytics required for the network solution.
• Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position.
• Creates and manages initiatives that improve total medical cost and quality.
• Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
• Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
• Creates “HCP” agreements that meet internal operational standards and external provider expectations.
• Ensures the accurate implementation, and administration through matrix partners.
• Leads in resolving elevated and complex provider service complaints.
• Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
• Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance.

Director, Network Management

Consultant

• Help shape the future of C&CE through data-driven analysis and business acumen
• Leverage data to answer business questions by identifying data needs, extracting data from relevant sources, and performing detailed analysis
• Use technical expertise (e.g., SQL, Python, PySpark) and analytical tools to explore operational data, identify trends, drivers, and outliers, and explain performance outcomes
• Design, build, and maintain standardized reports and dashboards that support C&CE operational reviews and decision-making
• Ensure data accuracy, consistency, and reliability through validation, reconciliation, and quality checks
• Partner closely with cross-functional stakeholder groups to align analytics outputs with business needs

Business Analytics Consultant, C&CE

Call Center Representative

• Own the product backlog and end-to-end delivery of IVR journeys and conversational voice experiences
• Translate customer needs, business objectives, and operational requirements into clear product requirements and user stories
• Partner with engineering, analytics, and operations teams to deliver scalable, reliable voice solutions
• Use data and customer feedback to identify opportunities and drive continuous improvement
• Support the transition from traditional menu-based IVR to intent-based, conversational voice experiences
• Ensure solutions meet privacy, regulatory, and operational requirements
• Communicate progress, risks, and trade-offs effectively to stakeholders and leadership

Product Manager, Voice & Contact Center Experience

Pharmacist

• Ensure process efficiency – Communicate with patients to coordinate fertility plans and medications.
• Own the patient experience through resolving customer issues and ensuring 100% follow-up to customers while delivering an excellent customer service experience to all patients.
• Pay attention to detail – Accurately obtain and enter patient information, including shipping, insurance, and payment details.
• Be a team player – Escalate complex claims to the appropriate team for further action.
• Accurately perform data entry tasks and enter prescriptions into our system.
• Use the knowledge you gain from training, your problem-solving skills and support from your team to accurately process prescription claims so they will be dispensed accurately.
• Juggle multiple tasks without sacrificing attention to detail.
• Participate in special projects and perform other duties as it pertains to specific contract performance.
• Maintain required quality performance standards by delivering excellent customer service, adhering to phone and break schedules, and following established call handling guidelines.

Senior Pharmacy Technician

Customer Success Manager

• Drive measurable behavior change by identifying, testing, and scaling high-value customer engagement opportunities aligned to business, product, and digital priorities
• Define customer-centric, data-driven engagement strategies, including target populations, use cases, channels, frequency, and success metrics
• Design and map end-to-end, multichannel customer journeys across email, SMS, push, web, mobile, and offline touchpoints
• Lead A/B/n experimentation by owning hypotheses, test briefs, measurement plans, and documented learnings
• Partner closely with product, analytics, technology, and delivery teams to execute experiments from concept through launch
• Build trusted relationships with cross-functional partners to align strategy, remove obstacles, and accelerate impact
• Translate insights into action by applying learnings to improve current campaigns and inform future strategies
• Create clear internal documentation and communications that enable alignment, transparency, and shared learning
• Manage approvals efficiently while maintaining momentum and quality

Customer Engagement Strategist

Manager

• Lead a team of consultants conducting deep dive assessments and process review initiatives across operational areas.
• Identify gaps, optimize workflows, and support improvement projects.
• Mentor Lean Six Sigma consultants on their day-to-day project management.
• Validate process maps and assess current workflows to identify gaps or structural issues that require improvement.
• Build relationships with senior leaders across various business areas.
• Drive innovation programs aligned with strategic objectives.
• Generate executive insights through data analysis and support evidence-based recommendations.
• Design long-term transformation plans and present proposals to enhance efficiency.

Operating Effectiveness Manager

Customer Support

• Manage approximately 75–100 inbound calls per day, assisting patients and members with professionalism and care
• Coordinate and schedule medication shipments to ensure timely delivery
• Provide updates on order status and answer questions clearly and accurately
• Support payment collection or co-pay assistance when applicable
• Transfer calls to appropriate departments when specialized support is needed
• Use sound judgment to resolve customer concerns and de-escalate challenging situations
• Maintain accuracy and efficiency while meeting performance and quality expectations
• Adapt to changing processes, systems, and patient needs in a fast-paced environment

Customer Service Representative

• Lead day-to-day chargeback, cash application, and adjustment operations across a team of 4–7 analysts, ensuring workload balance, service levels, and quality standards are met
• Oversee advanced analysis and resolution of complex payment discrepancies, pricing variances, contractual issues, and aged receivable items
• Ensure accurate application of cash and adjustments in accordance with audit controls, contractual terms, and internal policies
• Prepare and review End-of-Month reporting, ad hoc analyses, and management-level summaries
• Monitor team performance, productivity, and operational metrics to identify risks and drive timely corrective action
• Directly manage, coach, and develop a team of 4–7 analysts, including performance management, prioritization, and capability building
• Serve as the primary escalation point for complex chargeback and accounts receivable issues, ensuring timely resolution and clear ownership
• Provide guidance and subject matter expertise to support accurate and timely resolution of chargeback activity across the team
• Partner with the Senior Manager on workload planning, team development, and operational priorities
• Provide regular readouts and escalation insights to the Director, highlighting performance trends, key risks, and recommended actions
• Act as a key liaison between Chargeback Operations, Finance, Pricing, and external vendors to resolve disputes and systemic issues
• Assist in establishing and maintaining regular business reviews / touchpoints with top vendors
• Prepare data, insights, and discussion materials for vendor touchpoints to drive accountability, transparency, and continuous improvement
• Track vendor performance trends, recurring issues, and follow‑up actions resulting from business reviews
• Partner with internal stakeholders to align on vendor strategies, risks, and improvement opportunities
• Assist with spearheading projects focused on process efficiency, data cleanup, and operational improvements
• Identify gaps in current workflows, controls, or data quality and recommend sustainable solutions
• Partner with cross‑functional teams (Finance, Pricing, IT, Audit, Vendor Management) to implement process or system enhancements
• Document processes, controls, and best practices to support scalability and consistency across the team
• Support testing, validation, and adoption of system enhancements or process changes
• Ensure compliance with audit requirements, internal controls, and vendor‑specific deadlines
• Contribute to risk identification and mitigation efforts related to chargeback processing and vendor performance
• Provide leadership with data‑driven insights to inform prioritization and decision‑making

Eligibility Manager

• Support enterprise quality strategy through the design, automation, and optimization of quality monitoring systems using Verint, speech analytics, and AI-driven tools
• Help maintain scalable Automated Quality Management programs
• Drive insights from speech and transcription data
• Enable teams with actionable analytics and emerging tech solutions
• Build, configure, and maintain Automated Quality Management forms, questions, and scoring frameworks in Verint
• Translate business requirements into measurable quality behaviors with key stakeholders
• Test, validate, and refine automated scoring logic for accuracy
• Maintain governance and consistency across forms, KPIs, and deployments
• Support rollout, training, and adoption of AQM across business areas
• Lead all speech functionality efforts for assigned vertical (Contact Center, Specialty Services, Clinical)
• Align speech categories with operational priorities and quality goals
• Monitor category performance, refine triggers/phrases, and improve detection accuracy
• Use speech hit rate data to identify investigation opportunities
• Partner with WFO to improve transcription and data outcomes (phonetics boosting)
• Leverage Verint marketplace to explore and implement new ideas
• Develop and present storyboards by analyzing data and trends across verticals
• Support onboarding and training of new analysts (forms, alerts, categories, KPIs, thresholds)
• Build strong relationships with internal and external partners
• Creatively use data and technology to uncover opportunities and solutions
• Support rollout of new features (call recording, summarization, AI bots, transfer bots)
• Evaluate new tools and enhancements within Verint and beyond
• Partner with leadership on pilots and innovation initiatives
• Identify opportunities to reduce manual work through automation
• Create and maintain standard operating procedures

Senior Quality Review and Audit Analyst

Account Manager

• Responsible for ensuring clients and patients receive superior service
• Manages the day-to-day client relationship
• Accountable for core service delivery for clients working cross-functionally with all operational teams
• Proactively reviews performance metrics to promote client satisfaction, profitability, and retention
• Utilizes technology, tools, processes and resources to exceed clients' needs
• Collaborates with Account Directors on client activity, expectations, and service needs
• Manages day-to-day client relationships through comprehensive knowledge of client’s benefit plan and product offerings
• Responsible for timely management and execution of all client benefit requests
• Accountable for new group and specific product implementations

• Define and execute the multi-year operational strategy for Verity Solutions, aligned to enterprise goals and the broader Health System Services strategy
• Translate executive priorities into scalable operating plans, ensuring strong alignment across product, operations, regulatory, and client-facing teams
• Establish clear performance metrics, governance, and operating rhythms to drive accountability and results
• Lead the day-to-day operations of Verity Solutions, ensuring effective delivery across all offerings, including 340B services, technology-enabled solutions, and emerging product lines
• Oversee and optimize operational performance, including quality, efficiency, and service delivery outcomes across the organization
• Develop and implement new operational procedures, systems, and workflows to enhance efficiency, scalability, and consistency