The Cigna Group

Nurse

• Provide safe and effective administration of specialty medications, including IV infusion, in patients' homes
• Partner with pharmacists and care teams to ensure holistic patient well-being
• Document assessments, treatments, and progress to maintain accurate patient records
• Serve as the primary point of contact for patient updates and care coordination
• Demonstrate autonomy in clinical decision-making to achieve optimal outcomes

Specialty Infusion Field Nurse, Per Diem

Client Services Representative

• Own and support a book of business aligned to the CGHB National Account Segment
• Partner with Sales to build and sustain client relationships and enhance Cigna's reputation in the global market
• Own end-to-end service delivery and resolve client and customer needs in a timely and cost-effective manner
• Develop case-level service strategies and customized service solutions for plan administration
• Prioritize tasks and deliverables to achieve timely, high-quality outcomes
• Engage internal matrix partners on escalated issues involving billing, banking, eligibility, customer service, plan setup and claim payment
• Perform root-cause analysis and drive first-contact resolution
• Attend client meetings and provide insights on complex client and customer issues
• Facilitate engagement between Cigna subject-matter experts to execute client service strategy
• Manage issues through end-to-end resolution
• Partner with Sales, Underwriting and Operations on client-specific service strategies, growth opportunities and retail strategies
• Provide routine updates to the Sales account management team on at-risk service issues
• Monitor client health, account metrics and performance guarantees
• Conduct proactive service touchpoints regarding service scorecard/dashboard results
• Provide standard service reports to the account team and client
• Analyze data and trends and present results to the client

Client Service Executive

Account Executive

• Leverage pharmacy and healthcare expertise to meet Health Plan clients’ strategic goals and improve clinical and financial outcomes
• Develop and present comprehensive healthcare strategies aligned with client strategic goals
• Manage a book of moderately complex clients
• Analyze healthcare data and draw actionable insights
• Partner with Pharmacy Directors, Medical Directors, and clinical staff on comprehensive management plans
• Lead adoption of clinical solutions through consultative sales methods, client P&T presentations, and business reviews
• Lead custom formulary management recommendation discussions
• Partner with Account Executives and Finance/Formulary teams to manage rebate performance
• Lead development, preparation, and presentation of healthcare strategies
• Lead clinical client Strategic Planning and Review Consultation meetings
• Support client retention, loyalty, satisfaction, and solution sales opportunities
• Share best practices and interpret drug trends affecting health plan benefits
• Participate in process improvement initiatives
• Build trusted client relationships and communicate client feedback to internal partners
• Serve as the primary clinical resource and new-solution product expert

Clinical Account Executive – Health Plans

Pharmacist

• Monitor client coverage and assist pharmacists with order processing
• Triage and manage high-volume client calls
• Provide basic technical support and coordinate with IT for advanced issues
• Contact healthcare professionals to gather required clinical or demographic information
• Support workflow during downtime
• Help secure emergency shift coverage
• Submit nightly shift reports
• Collect and document accurate patient medication histories
• Assist pharmacists
• Perform related clinical and administrative tasks

Pharmacy Technician Associate

Advocate

• Review sold plan documents, PIFs, and supporting materials to confirm client intent, product standards, and applicable requirements before implementation
• Use Crystal daily to review, enter, and update benefit information for new business, renewals, upsells, maintenance requests, and off-cycle changes
• Apply Diamond knowledge to understand MEDDEF-level benefit configuration and identify downstream impacts and discrepancies
• Participate in installation and expert-team meetings, explain benefit findings, and provide recommendations to commercial and operational partners
• Validate PIF information against sold benefits and support accurate downstream setup, contract documentation, certificates, and claim payment
• Research complex benefit questions, resolve quality issues, and coordinate corrections with client-facing and benefits teams
• Advise Sales and Client Management on nonstandard benefit options and appropriate Crystal entry
• Complete quality reviews within daily deadlines while managing multiple priorities and sensitive implementation timelines
• Support user acceptance testing, process improvements, and enhancements to Crystal, Diamond-related workflows, documentation, and team procedures
• Work independently through situations without fully documented processes, using sound judgment and escalating questions when appropriate

Senior Benefit Advocate

General Counsel

• Independently lead investigations from intake through resolution
• Formulate investigation strategies, conduct interviews, review documents, and debrief stakeholders
• Mentor non-attorney investigators on legal standards, documentation, and case handling
• Promptly assess, respond to, investigate, and resolve compliance and ethics inquiries and alleged employee misconduct
• Partner with e-discovery and forensic investigators to identify, preserve, and obtain relevant documents and data
• Draft reports and communicate findings to legal and business leaders
• Collaborate with HR on employment-related outcomes and disciplinary actions
• Conduct root cause analyses and determine appropriate remedial or corrective actions
• Evaluate whether matters, findings, or conclusions should be disclosed to federal and/or state agencies
• Ensure appropriate policies, procedures, training, and education programs are adopted based on investigation findings
• Promote a culture of accountability, transparency, and compliance

Counsel – Enterprise Investigations

Business Analyst

• Lead complex case planning from intake through resolution
• Align clinical needs, benefits, and community resources to support safe, timely care
• Partner with members, families, providers, and internal teams to set goals and track health outcomes
• Coordinate services across inpatient, rehabilitation, outpatient, and preventive settings
• Adjust care plans as members' needs change
• Use utilization review and documentation to ensure services meet criteria and benefits are maximized
• Coach members on conditions, treatment options, and next steps
• Escalate quality-of-care and complex clinical questions to the Medical Director
• Support quality reviews and lead risk meetings as needed
• Mentor new team members

Senior Case Management Analyst

Analyst

• Conduct medical record reviews and accurately abstract diagnosis codes according to Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS Protocols, and applicable rules
• Use the HHS Risk Adjustment Model to confirm HCC accuracy from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year
• Apply longitudinal thinking to identify valid data elements and data-capture opportunities under HHS Risk Adjustment
• Perform documentation and data audits to identify risk-adjustment data gaps, inaccuracies, and compliance risks
• Support IFP Risk Adjustment programs, including RADV audits and the Supplement Diagnosis submission program
• Conduct quality audits of vendor coding partners
• Collaborate with team members and matrix partners on coding and Risk Adjustment education for internal and external partners
• Coordinate with stakeholders to execute efficient and compliant Risk Adjustment programs
• Escalate identified risks and program gaps to management in a timely manner
• Develop and implement internal program processes supporting CMS/HHS-compliant programs
• Contribute to Cigna IFP Coding Guideline updates and policy determinations as needed

Quality Review and Audit Analyst

• Interpret physicians' or prescribers' prescriptions
• Contact doctors or other prescribers and/or patients to verify prescription information and expedite order processing
• Consult with patients regarding medication use and potential drug interactions
• Track order status and outstanding issues
• Handle customer calls regarding lost orders or dispensing errors
• Maintain daily production, quality, and service levels
• Vary work priorities and activities to accommodate business needs
• Contact physicians for new and/or transfer authorization
• Collaborate with physicians to convert prescriptions to generic or preferred drugs whenever possible
• Verify prescription information entered by data entry or order entry
• Back up other pharmacists as needed
• Train less experienced pharmacists
• Perform additional duties assigned by management

Patient Consultation Staff Pharmacist – Oncology

Manager

• Assess customer needs, develop individualized care plans, and document interventions and outcomes in Cigna medical management systems
• Collaborate with customers and providers to establish goals, interventions, and evidence-based plans of care
• Apply motivational interviewing, behavior change strategies, and shared decision-making to improve engagement and health outcomes
• Empower customers to navigate the healthcare system and communicate with providers
• Coordinate care across customers, caregivers, providers, and internal partners via phone and digital channels including email, text, and chat
• Collaborate with interdisciplinary teams including pharmacists, nutritionists, behavioral clinicians, Medical Directors, and Medical Management programs
• Track, analyze, and document daily activity, volume, and outcomes to support performance and quality goals
• Follow established policies, procedures, and Case Management performance measures
• Navigate multiple systems and applications in a fast-paced, customer-focused environment
• Complete required training and maintain clinical knowledge, licensure, and certifications

Oncology Nurse Case Manager

• Assess customer needs, develop individualized care plans, and document interventions and outcomes in Cigna medical management systems
• Collaborate with customers and providers to establish goals, interventions, and evidence-based plans of care
• Apply motivational interviewing, behavior change strategies, and shared decision-making to drive engagement and improved health outcomes
• Empower customers to navigate the healthcare system and communicate with providers
• Coordinate care across customers, caregivers, providers, and internal partners via phone and digital channels
• Collaborate with interdisciplinary teams, including pharmacists, nutritionists, behavioral clinicians, Medical Directors, and Medical Management programs
• Track, analyze, and document daily activity, volume, and outcomes to support performance and quality goals
• Follow established policies, procedures, and Case Management performance measures
• Navigate multiple systems and applications in a fast-paced, customer-focused environment
• Complete required training and maintain clinical knowledge, licensure, and certifications

Community Manager

• Develop, evolve, and own the enterprise community management and social engagement strategy
• Build and maintain a multi-year engagement model and roadmap identifying audiences and channels
• Define the operating model connecting community, brand storytelling, influencer marketing, and social intelligence
• Establish annual and quarterly plans supporting enterprise brand, business, and reputation goals
• Own engagement policies, response playbooks, brand voice guardrails, escalation protocols, and crisis response
• Partner with Brand, Legal, Compliance, Public Affairs, and Communications on regulatory and enterprise standards
• Establish moderation standards, SLAs, and quality assurance frameworks across internal teams and agencies
• Lead company-wide governance processes and community management best practices
• Lead, manage, coach, and inspire community managers, care specialists, moderators, and analysts
• Develop recruitment, onboarding, coaching, retention, and succession strategies
• Foster a collaborative, accountable, learning-focused, and agile high-performance culture
• Champion employee well-being and resilience
• Serve as primary liaison between the community program and enterprise stakeholders
• Communicate strategies, priorities, progress, and outcomes across the organization
• Advocate for community management and customer engagement
• Own the enterprise community measurement framework
• Translate social listening and community signals into business insights and recommendations
• Deliver executive-ready reporting, dashboards, and quarterly business reviews
• Monitor competitors, industry trends, emerging platforms, and evolving community behaviors
• Manage community operations budgets, staffing, tools, technology, and agency investments
• Oversee listening, moderation, engagement, and analytics platforms
• Manage agency and vendor relationships and return on investment
• Evaluate emerging technologies and recommend future-state capabilities

Director, Social Engagement – Community Management

Infrastructure Engineer

• Lead the design, engineering, and implementation of complex CICS infrastructure solutions supporting enterprise business objectives
• Provide technical leadership for large-scale mainframe initiatives from strategy through execution
• Build, support, and continuously improve highly available CICS environments
• Partner with application development teams and infrastructure stakeholders to deliver scalable, secure, and reliable solutions
• Evaluate emerging technologies and recommend approaches that improve performance, resiliency, and operational efficiency
• Diagnose complex infrastructure and application issues, identify root causes, and implement long-term solutions
• Install, configure, maintain, and optimize CICS and associated system software products
• Provide expertise in CICSPlex System Manager (CPSM), DB2 Data Sharing, MQ Shared Queue Managers, REXX, and z/OS
• Provide guidance and consultation to a large and diverse application development organization
• Participate in an on-call rotation and support high-priority production events as needed

CICS Systems Programmer – Infrastructure Engineering Senior Advisor

Medical Director

• Perform benefit-driven medical necessity reviews for coverage, case management, and claims resolution
• Use benefit plan information, federal and state regulations, clinical guidelines, and best-practice principles
• Achieve quality outcomes for customers and members while focusing on service and cost
• Improve clinical outcomes through interactions with health care professionals, including listening, education, communication, and negotiation
• Balance customer/member needs with business needs while advocating for customers and members
• Participate in all appropriate levels of the appeal process
• Participate in coverage guideline development and medical management projects, initiatives, and committees
• Participate in audits, inter-rater reliability clinical reviews, and quality projects
• Mentor or coach Medical Directors and colleagues in quality and performance improvement
• Improve health care professional relations through direct communication and evidence-based clinical information
• Apply evidence-based guidelines, including novel treatments, to peer review across medical and behavioral health conditions
• Maintain knowledge through monthly updates to Cigna coverage policies, inter-rater reliability testing, continuing medical education, and board certification maintenance
• Address customer service issues with leadership support
• Investigate and respond to client and regulatory questions
• Support timely coverage reviews and quality outcomes for regulatory and accreditation compliance
• Provide clinical insight and management support to functional areas and matrix partners

Financial Planning and Analysis

• Complete pricing-related activities for “Full Contracted Retail Value” transparent clients, including custom network pricing
• Develop and maintain price points on client pricing files
• Coordinate with Network Ops to ensure production price points reflect desired rates
• Monitor and track client and provider performance
• Build monthly client accrual and reconciliation reporting
• Complete financial assessments of re-contracted retail network rates
• Design and implement tools and financial models for forecasting, reporting, and analysis
• Develop reporting for annual plan, monthly operating report, and mid-year projection discussions
• Meet collaboratively with clients to discuss financial or operational issues and opportunities
• Participate in client interactions to build relationships, direct strategy, and triage issues
• Collaborate with health plan retail network clients, account management, supply chain, financial client operations, pricing, and external client partners

Specialty Infusion Field Nurse, Per Diem

Client Service Executive

Clinical Account Executive – Health Plans

Pharmacy Technician Associate

Senior Benefit Advocate

Counsel – Enterprise Investigations

Senior Case Management Analyst

Quality Review and Audit Analyst

Patient Consultation Staff Pharmacist – Oncology

Oncology Nurse Case Manager

Oncology Nurse Case Manager

Director, Social Engagement – Community Management

CICS Systems Programmer – Infrastructure Engineering Senior Advisor

Medical Director

Financial Analysis Advisor, Retail Network