Senior Operating Effectiveness Analyst

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $63.4k - $105.6k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Design, develop, maintain, and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows • Translate clinical guidelines, business requirements, regulatory standards, and client needs into system logic, workflow configurations, and decision-support solutions • Partner with Clinical, Operations, Product, Technology, Data, and Business stakeholders on automation, AI integration, workflow simplification, and operational effectiveness improvements • Use data analysis, critical thinking, and root cause methodologies to resolve operational issues and drive continuous process improvement • Develop scalable solutions for clinical decision-making, automated rationale generation, letter production, utilization management operations, and user experiences • Conduct functional, regression, and quality assurance testing • Monitor system performance, user feedback, and operational metrics to identify enhancements • Create and maintain process documentation, standard operating procedures, workflow diagrams, training materials, and governance controls • Support new programs, enhancements, and enterprise initiatives through testing, training, deployment, and change management • Ensure alignment with regulatory, accreditation, compliance, privacy, and quality standards including HIPAA, NCQA, and URAC • Use reporting, analytics, and emerging AI technologies to improve decision accuracy, reduce manual effort, and increase scalability

🎯 Requirements

• Bachelor's degree in Science, Healthcare Administration, Computer Science, Data Analytics, Mathematics, Information Systems, or a related field, or equivalent experience • Experience in healthcare operations, utilization management, clinical decision support, product operations, process improvement, or business systems analysis • Strong analytical, problem-solving, communication, and stakeholder management skills • Experience translating business requirements into workflows, decision logic, pathways, algorithms, or system configurations • Knowledge of workflow design tools, business rules engines, Visio, SharePoint, Tableau, SQL, Databricks, or similar analytics and process automation technologies preferred • Experience supporting AI-enabled solutions, automation initiatives, intelligent workflow platforms, or decision-support technologies preferred • Ability to balance operational execution with strategic thinking, innovation, and continuous improvement • Home internet connection through a cable broadband or fiber optic internet service provider with at least 10Mbps download and 5Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work arrangement • Cable broadband or fiber optic internet service requirement for home working