Senior Operating Effectiveness Analyst

The Cigna Group

. Design, develop, maintain, and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows .

Posted 9/29/2026full-timeRemote • United StatesSenior💰 $63,400 - $105,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in designing and optimizing clinical decision-support pathways and workflows, with a strong focus on regulatory compliance and process improvement. Proficient in utilizing data analysis and AI technologies to enhance operational effectiveness and decision accuracy.

Highest-signal resume keywords

Clinical Decision SupportWorkflow DesignData AnalysisRegulatory ComplianceProcess Improvement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

AlgorithmsBusiness RulesAutomated WorkflowsUtilization ManagementSystem ConfigurationsQuality Assurance TestingData AnalyticsProcess AutomationAI IntegrationCritical Thinking

Soft Skills

Analytical SkillsProblem-SolvingCommunicationStakeholder Management

Tools & Technologies

VisioSharePointTableauSQLDatabricksWorkflow Design ToolsBusiness Rules Engines

Industry Keywords

Healthcare OperationsUtilization ManagementRegulatory StandardsHIPAANCQAURAC

Tech Stack

Tools & technologies

SQLTableau

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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