Candidates who reside within 50 miles of the following locations may be asked to work in person: Bloomfield, CT, Chattanooga, TN, Denver, CO, St Louis, MO, and Scottsdale, AZ. Role Summary This role supports strategic claim pricing and reimbursement operations by monitoring performance, analyzing trends, and driving continuous improvement. It partners across business, operations, and technology teams to ensure accurate, timely, and efficient claim payment outcomes while enabling operational readiness and successful delivery of initiatives.

Key Responsibilities

• Lead triage, prioritization, resolution of incidents and operational fallout to maintain system stability and minimize business disruption.
• Analyze system performance, data trends, and outputs to identify risks, anomalies, and root causes, and drive corrective and preventive actions.
• Monitor claim pricing systems and workbaskets to proactively detect and address operational issues impacting claim payment accuracy.
• Validate and optimize pricing rules to ensure alignment with business requirements, regulatory expectations, and operational effectiveness.
• Serve as a subject matter expert, aligning cross-functional stakeholders on priorities, ownership, and resolution strategies.
• Lead and support cross-functional initiatives, ensuring effective planning, coordination, and execution across teams.
• Identify and implement process improvements to enhance system performance, efficiency, and quality outcomes.
• Manage dependencies, risks, and issues across initiatives, ensuring timely delivery and operational readiness.
• Provide clear, concise reporting and communication to stakeholders and leadership on performance, risks, and progress.
• Support process design, change readiness, and adoption of new capabilities through business and technical insight.
• Drive continuous improvement through post-implementation reviews, insights generation, and process optimization.

Required Qualifications

• High School Diploma or G.E.D.
• 3+ years of experience in claims, claim pricing, or related healthcare operational environments.
• Strong analytical and problem-solving skills with the ability to interpret complex data and drive actionable insights.
• Demonstrated ability to lead initiatives and collaborate effectively in a matrixed environment.
• Strong communication and influencing skills, with the ability to engage stakeholders at all levels.
• Experience with claim payment or pricing systems and business rules (e.g., Facets, Proclaim, Enterprise Pricing Service, NetworX).
• Proficiency in data analysis tools such as Microsoft Excel and other reporting tools.
• Experience working in Agile or continuous improvement environments.

Preferred Qualifications

• Bachelor's degree or equivalent work experience.
• Experience with PEGA applications or related pricing tools.
• Experience supporting large-scale, cross-functional transformation or system implementation initiatives.
• Knowledge of healthcare claims operations, pricing logic, and reimbursement methodologies.
• Experience with process improvement methodologies such as Lean or Six Sigma.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 82,400 - 137,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.