Operations Advisor

Claims Project Advisor

This role is responsible for supporting the delivery of projects and business process enhancements. The position requires the ability to work independently and handle multiple tasks which may entail tight deadlines. The successful candidate will be able to demonstrate the ability to navigate across different business departments including the global organization, especially with Agile, Claims and Technology teams. There may be interactions with external partners to establish the right data exchanges, controls and implementations to meet business needs.

• Defines, develops and provides information and analysis to drive the decision-making process and support business operations for internal and external customers.
• Understands Claims EDI processes and codes sets.  Ability to troubleshoot and problem solve issues with claim processing.
• Integral partner with Scrum teams to define claims related initiatives, business value/business cases, business requirements and outcomes.
• May assist with researching, analyzing and recommending operational policies/processes/ procedures to standardize and develop best practices for the organization.
• Tactical focus, expertise in at least one business process area, works with guidance to scope, plan and manage small-scale, department projects.
• Able to oversee UAT testing and work with the Agile/project/IT teams to successfully deliver projects and enhancements.
• Knowledgeable in the applications used to support the various departments in a Healthcare payor environment, including in International Healthcare.
• To advise process and policy procedure updates as to drive efficiency and effectiveness in the claims operations.
• Lead (via strong coordination) the development and sign off of business requirements, change controls, and user acceptance testing.
• Forward thinking approach on areas like AI, process minging, automation and controls to drive operating expenses lower while enhancing claims quality. 
• Support medical cost affordability initiatives as and when needed.

Qualifications

• At least 10+ years of business experience in healthcare payor claims operations/technology (International experience is a big plus)
• Understanding US or other claim EDI transactions, code sets and processes is required, experience in international claims is a plus.
• Bachelor’s degree in business, operations, engineering or similar fields required, Master’s Degree preferred
• Ability to ramp up and function in a fast-paced environment and prioritize multiple tasks under tight deadlines
• Ability to influence and drive results
• Strong background working in Agile scrum teams or as part of project delivery teams
• Strong organizational and interpersonal skills, utilized in team settings at various levels
• Demonstrates superior communication; written, oral and listening skills
• Exceptional analytical and problem-solving skills
• Ability to develop strong working relationships with internal and external partners in a team environment

About The Cigna Group