Issue Resolution Lead Analyst, Individual Dental Operations

🔥 1 hour ago

🏰 Missouri, Pennsylvania, +2 more states – Remote

🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $62.6k - $104.3k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Manage assigned customer issue intake queues by tracking, prioritizing, researching, documenting, resolving, and closing cases • Research and resolve complex or sensitive customer issues, complaints, Senior Leadership inquiries, and Department of Insurance matters • Support inquiries received through federal exchange and state-based marketplace channels • Evaluate customer needs, determine next steps, and develop effective resolutions • Communicate findings, decisions, and resolutions to customers, business partners, and leadership • Maintain complete and accurate case documentation • Monitor case activity and turnaround times for regulatory and internal compliance • Identify and escalate compliance risks, missed dependencies, or barriers to timely resolution • Apply marketplace, dental-product, and customer-issue resolution requirements • Protect customer information and follow privacy, security, documentation, and records-management requirements • Support audits, compliance reviews, and operational inquiries with case information and subject matter expertise • Analyze issues and case activity to identify trends, process gaps, and emerging risks • Document findings and recommend improvements to processes, workflows, controls, communications, and documentation • Participate in operational projects, business testing, and process-improvement initiatives • Provide frontline observations and subject matter expertise to improve customer experience and operational effectiveness • Validate process changes and confirm solutions address business needs • Provide technical guidance and knowledge sharing to team members • Partner with Operations, Compliance, Customer Service, and business support teams • Build relationships with matrix partners • Share trends, risks, and lessons learned • Independently manage workload, competing priorities, and time-sensitive requests

🎯 Requirements

• Minimum of three years of healthcare insurance business experience in benefits, eligibility, claims, customer service, contact center operations, sales, or business operations • Minimum of two years of experience handling complex Stand-Alone Dental customer inquiries • Current experience within IFP, including marketplace operations, regulatory requirements, and customer issue resolution processes • Understanding of federal exchange and state-based marketplace environments • Knowledge of customer issue research, case management, escalation handling, and documentation requirements • Ability to manage multiple priorities, meet tight deadlines, and adjust to changing business needs • Strong analytical, decision-making, and problem-solving skills • Ability to apply technical knowledge, business processes, and available resources to drive accurate and timely resolution • Strong verbal and written communication skills, including documenting complex findings clearly and professionally • Proficiency with Microsoft Office applications and internal systems used to support IFP and Dental operations • Ability to work additional hours and adjust planned time off during peak operating periods • For home work, cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload • Preferred: experience with Senior Leadership escalations, Health Insurance Casework System matters, or Department of Insurance casework • Preferred: experience with IFP Dental products, systems, and processes, including Dentacom, Dentaque, OneView, and claim-processing guidelines • Preferred: experience supporting operational testing, trend analysis, process improvement, or business documentation • Preferred: experience providing technical guidance, peer support, or informal leadership

🏖️ Benefits

• Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs starting on day one • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Annual bonus plan eligibility • Remote work arrangement