Senior Operating Effectiveness Analyst

🔥 0 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

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

• 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 • 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 and 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 solutions align with HIPAA, NCQA, URAC, regulatory, accreditation, compliance, privacy, and quality standards • 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 • For home work, cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits • 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