IOH Provider Claims SME

The IOH Provider Claims SME plays a critical role in supporting Senior Supervisor by serving as a subject matter expert in Claims processes, systems, and operational best practices. This role combines deep technical and procedural expertise with a strong focus on continuous improvement, process mapping and optimization, and knowledge sharing. The SME acts as the primary point of contact for process-related guidance, training and stakeholder engagement while helping drive operational excellence across the organization.

Your role includes:

• Building and maintaining a solid in-depth knowledge of (part of) your process.
• Being an expert user of any of the tools used within the team and/or any of the partner set-ups in place.
• Being the organizational ambassador for your knowledge area within your own team and across the wider organization. You are the go-to person in case of questions on your area of expertise.
• In that role, being able to represent the Process / Organization in (enterprise-wide) projects, stakeholder meetings, act as a relationship manager towards some of our (internal/external) strategic partners, or act as a trainer.
• Being proactive in identifying improvement and enhancement opportunities and actively seeking and sharing ideas for innovation in business processes.
• Mapping, documenting, reviewing, and optimizing end-to-end business processes to improve operational efficiency, quality, compliance, and customer experience.
• Identifying process bottlenecks, inefficiencies, risks, and control gaps through detailed process analysis and root cause investigations.
• Maintaining accurate process documentation, standard operating procedures (SOPs), workflows, and process maps to support knowledge management and operational excellence.
• Collaborating with stakeholders to design, implement, and monitor process improvements based on data and business requirements.
• Monitoring process performance through KPIs and recommending enhancements to improve productivity, quality, and customer outcomes.
• Supporting business transformation, automation, and continuous improvement initiatives through process expertise and process mapping capabilities.
• Striving to provide excellent service to our Providers, Members, and Clients.
• Playing an active role in a culture of continuous improvement.
• Reviewing available documentation on the knowledge management tool. Creating new documents and amending existing ones according to business needs. Removing obsolete documentation.
• Taking ownership of solving any issues (if applicable) within your area of expertise.
• Proactively addressing and/or escalating any risks.
• Developing and maintaining proactive and effective business relationships internally, externally, and with BPO partners to ensure seamless service delivery.
• Supporting process standardization and governance activities to ensure consistent execution across teams and locations.
• Leading process walkthroughs, knowledge-sharing sessions, and training related to process improvements and best practices.
• On-site training and support for new hires.

Specific for IOH Provider Claims SMEs:

• Support the financial verification of the team, including approval of manual payments.
• Support quality audits (financial verification and extra verification) with a clear focus on the financial and procedural accuracy company KPIs. Document findings, share them with the Supervisor, and discuss corrective actions at both individual and team level.
• Responsible for providing training on specific topics where you act as a subject matter expert, whether on a process or a client, including leading training organization and coordination.
• Lead the onboarding and training phase of new hires or colleagues taking up new accounts, including performance reporting.
• Building and maintaining a solid escalation path for both in-house and BPO partners.
• Support BPO partners for out-of-scope tasks and escalations.
• Analyze process performance trends and identify opportunities for procedural improvements, standardization, and operational efficiencies.
• Support the design, documentation, and implementation of process improvements impacting Claims operations and BPO partnerships.

YOUR PROFILE

• Strong performance track record.
• International mindset, with a holistic approach and the ability to work remotely with peers across locations.
• 1 year of experience working at Cigna.
• 2 years of experience in a Claims role.
• Claims IOH processes experience.
• Fluency in English.
• Good communication skills and knowledge of Windows tools, e.g., Excel, PowerPoint, and Windows.
• Strong process mapping and process documentation skills, with the ability to analyze and visualize end-to-end workflows.
• Experience in process improvement methodologies such as Lean, Six Sigma, Kaizen, or equivalent continuous improvement frameworks.
• Strong analytical and problem-solving skills with the ability to identify root causes and develop sustainable solutions.
• Ability to translate complex operational processes into clear procedures, process maps, work instructions, and training materials.
• Experience supporting change management and operational excellence initiatives.
• Strong stakeholder management and facilitation skills, including leading process workshops and improvement discussions.
• Advanced Excel, reporting, and data analysis skills.
• A growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives within your process.
• Action-orientated problem-solving attitude.
• Able to seek out best practices to effectively deal with diverse, complex, and highly sensitive issues.
• Accountability – assumes ownership for achieving personal results and collective team goals.

Please include your CV and cover letter in the application.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.