The Cigna Group

Quality Specialist

• Provide remote, patient-centered case management support and education to assigned patients
• Build and maintain therapeutic relationships with assigned patients
• Deliver patient-centric education regarding treatments, disease states, and prescribed products
• Manage a designated caseload through scheduled outreach, adherence monitoring, and accurate database documentation
• Coordinate interactions between patients and internal or external clinical partners
• Customize interactions based on individual patient needs, health literacy, and program requirements
• Participate in customer meetings, training sessions, and orientations
• Demonstrate clinical competency and system proficiency through required assessments
• Support special projects and additional duties aligned to contract performance and business needs
• Adhere to contractual agreements, company policies, quality standards, and compliance requirements
• Work 11:00 a.m. – 8:00 p.m. Eastern Time

RN Quality Specialist

Sales

• Serve as the primary support partner for assigned sellers
• Support strategic opportunities from RFP through contracting and implementation intake
• Support Sales Directors through complex solutioning efforts
• Coordinate cross-functional resources for complex sales pursuits
• Identify and mitigate risks affecting strategic opportunity progression
• Facilitate issue escalation and resolution for high-value opportunities
• Provide Pitch Team details for executive-level presentations and pursuit materials
• Tailor account messaging with Marketing and Content teams
• Support solution positioning and value proposition development
• Capture reusable assets for future pursuits
• Partner with Bid & Contract Execution teams during negotiations
• Coordinate contract deliverables and stakeholder engagement
• Assist with exception management, signature control, and contracting barriers
• Ensure proposal-to-contract continuity
• Support implementation intake and transition activities
• Coordinate SME engagement and follow-up
• Facilitate finalist preparation activities
• Facilitate recurring seller strategy meetings
• Ensure accountability for key deliverables across internal stakeholders
• Identify process automation and efficiency opportunities
• Support AI-enabled content development initiatives
• Improve knowledge management and asset reuse
• Recommend scalable solutions based on recurring seller needs

Strategic Sales Support Advisor

Customer Support

• Answer inbound calls from members, providers, and pharmacies about Pharmacy Benefit Management benefits and mail-order pharmacies
• Handle an average of 70–80 calls daily
• Take back-to-back calls while toggling through several applications on multiple screens
• Attend 100% of trainings and during the first 90 days of employment
• Maintain regular and predictable attendance
• Resolve customer complaints through independent problem-solving and one-call resolution
• Meet or exceed call center metrics while providing consistent customer service
• Foster teamwork and partnership with cross-functional departments to resolve issues and improve customer experience

Customer Service Representative

Clinical Operations

• Lead assigned clinical operations programs and teams
• Oversee day-to-day execution while improving performance, quality, efficiency, and scalability
• Provide operational leadership for behavioral health programs and workflows, including care coordination, referrals, and patient and provider support
• Design, implement, and manage clinical-program workflows, procedures, performance measures, escalation pathways, and operational controls
• Lead, mentor, and develop clinical and operational team members through coaching, performance management, goal setting, professional development, and accountability
• Partner with Behavioral Leaders, Nursing, Medical Affairs, Operations, Product, and Technology
• Identify root causes, eliminate unnecessary manual work, and develop sustainable solutions
• Establish, monitor, analyze, and report operational and clinical performance metrics
• Identify trends, emerging risks, capacity concerns, and improvement opportunities using data
• Lead teams through new programs, technology changes, workflow redesigns, and organizational initiatives
• Provide leadership and decision support for complex patient, provider, and workflow escalations
• Ensure operations comply with organizational policies, clinical standards, regulatory requirements, privacy requirements, and best practices
• Support staffing, scheduling, workload management, and resource planning
• Develop and implement onboarding, training, job aids, procedures, and performance-support resources
• Provide leadership during urgent operational events, system outages, and significant workflow disruptions
• Lead or participate in cross-functional initiatives and special projects
• Protect Protected Health Information and Personally Identifiable Information in accordance with applicable regulations and company policies
• Perform duties in a remote, HIPAA-compliant home office with minimal travel

Behavioral Health Clinical Operations Manager

Product Adoption Specialist

• Lead the Adoption Center strategy and align adoption work to enterprise transformation goals, capability roadmaps, and long-term business outcomes
• Guide simulation and validation, insight generation, issue management, scaling, and sustainment functions
• Partner with programs, technology, operations, PX&O, Data Management, Reporting, Knowledge Management, Training, Communications, Risk Control, and Audit
• Develop Adoption Business Plans connecting insights, risks, lessons learned, and adoption needs to clear actions
• Use data, performance measures, and operational insights to identify risks and improve decisions
• Represent the Adoption Center in governance forums, program discussions, and operational report-outs
• Coach and empower teams to manage ambiguity, solve adoption challenges, and build collaboration, learning, innovation, and accountability

Senior Adoption Manager – Delivery Support, Insights

Advocate

• Answer inbound claim calls from members or providers, as well as contracting and Provider Relations calls from providers
• Spend the majority of the day answering calls from a queue in a structured work environment
• Make occasional outbound calls to follow up on issues and resolve claim problems
• Assist members or providers with understanding how claims have processed
• Verify claim status
• Educate members and providers on billing protocols
• Write or correct authorizations to ensure claims are paid correctly
• Send claims for adjustment or reprocessing across multiple claim platforms
• Request duplicate EOBs
• Request cancelled check copies, check reissues, or stop-pay/do-not-reissue actions
• Send resources to members and providers by email
• Submit complaints on behalf of members or providers
• Send Advocate Handoff/Help Requests for escalated or complex issues
• Assist providers with contract-related inquiries and demographic updates
• Independently problem-solve to provide accurate information, exceptional customer service, and first-call resolution

Claims & Provider Relations Advocate

Pharmacist

• Interpret and evaluate physician medication orders
• Accurately prepare, calculate, and dispense medications under Pennsylvania and federal regulations
• Identify and report suspected adverse drug reactions
• Support formulary stewardship and therapeutic interchange protocols
• Review and maintain patient medication records for allergies, interactions, and therapeutic duplications
• Organize daily pharmacy operations and guide pharmacy technicians, aides, interns, and other personnel
• Ensure compliance with regulatory requirements, professional standards, and hospital quality policies
• Communicate with physicians, nurses, and care teams about medication orders and care decisions
• Provide drug information, education, and support to healthcare professionals and pharmacy students
• Use pharmacy information systems and clinical databases
• Process and verify prescription orders
• Participate in rotating shifts, on-call responsibilities, weekends, evenings, and holidays

Pharmacist, Home Infusion

• Lead the Adoption Center strategy and align adoption work with enterprise transformation goals, capability roadmaps, and long-term business outcomes
• Guide simulation and validation, insight generation, issue management, scaling, and sustainment functions
• Partner across programs, technology, operations, PX&O, Data Management, Reporting, Knowledge Management, Training, Communications, Risk Control, and Audit
• Develop Adoption Business Plans connecting insights, risks, lessons learned, and adoption needs to clear actions
• Use data, performance measures, and operational insights to identify risks and improve decisions
• Represent the Adoption Center in governance forums, program discussions, and operational report-outs
• Coach and empower teams to manage ambiguity, solve adoption challenges, and build collaboration, learning, innovation, and accountability

Senior Adoption Manager – Delivery Support & Insights

Analyst

• Administer employee recognition programs by processing recognition awards, validating data, and ensuring timely program execution
• Manage weekly recognition file loads and program award processing
• Conduct monthly and quarterly audits of compensation and recognition data
• Identify discrepancies and strengthen data quality and process accuracy
• Reconcile recognition program invoices and finance reports
• Research, resolve, and document employee recognition and compensation inquiries through HR Central
• Maintain recognition resources, including knowledge articles, forms, and process documentation
• Produce and support recognition and compensation reporting requests
• Partner with HR, Finance, and business stakeholders to resolve issues and improve processes
• Contribute to ongoing projects and continuous improvement initiatives
• Support compensation operations, including reviewing compensation offers, processing job and pay changes, data validation, and assisting with surveys and market pricing activities

Compensation & Recognition Analyst

Bilingual

• Provide onsite face-to-face customer coaching and support
• Identify customer health education needs through targeted health assessment activities
• Refer customers to Cigna Evernorth clinical programs or client-specific programs as clinically appropriate
• Establish health improvement plans, set personalized evidence-based goals, and support customers in achieving them
• Empower customers to participate actively in their health outcomes
• Assist customers in overcoming barriers to better health
• Lead and support health and wellness promotional activities, including group coaching, wellness challenges, and health-related seminars
• Perform biometric screenings, including finger sticks, blood pressure, and body composition, as needed
• Use biometric values and motivational interviewing techniques to improve clinical outcomes
• Support health-related site events, including open enrollment, wellness committee facilitation, flu shot events, and health fairs
• Collaborate with matrix partners to support the aligned client’s overall health and wellness strategy
• Split time between client locations in Arlington, Virginia and McLean, Virginia

RN, Bilingual Onsite Health Coach

• Answer inbound calls from members, providers, and pharmacies about Pharmacy Benefit Management benefits and mail-order pharmacies
• Handle an average of 70–80 calls daily
• Take back-to-back calls while toggling through several applications on multiple screens
• Resolve customer complaints through independent problem-solving and one-call resolution
• Meet or exceed call center metrics while providing consistent customer service
• Foster teamwork and partnership with cross-functional departments to resolve issues and improve customer experience

Health Coach

• Provide onsite face-to-face customer coaching and support
• Identify customer health education needs through targeted health assessment activities
• Refer customers to Cigna Evernorth clinical or client-specific programs as clinically appropriate
• Establish health improvement plans and personalized evidence-based goals with customers
• Support customers in achieving their health goals and becoming active participants in their health outcomes
• Assist customers in overcoming barriers to better health
• Lead and support health and wellness promotional activities, including group coaching, wellness challenges, and health-related seminars
• Perform biometric screenings such as finger sticks, blood pressure, and body composition measurements
• Use biometric values and motivational interviewing techniques to improve clinical outcomes
• Support health-related site events, including open enrollment, wellness committee facilitation, flu shot events, and health fairs
• Collaborate with matrix partners to support the aligned client’s overall health and wellness strategy
• Split time between several client locations across greater Boston, Massachusetts

RN Onsite Health Coach

• Lead and manage resolution of complex issues involving multiple clients and customers reported to the Pharmacy Reliability team
• Triage, research, and resolve single-member issues requiring escalation support from business partners
• Assess complex client issues using Pharmacy benefit design knowledge, including cost, contractual, and legal implications
• Summarize issues and impacts, identify stakeholders, and communicate results
• Partner with Customer Service, Claims, Client Implementation & Service, and PBM vendors to ensure timely and accurate reimbursement
• Identify barriers and escalate issues to engage appropriate business units and stakeholders
• Improve processes, products, and services using best practices
• Identify root causes and determine preventive measures for Client Service Issues
• Develop partnerships across Pharmacy Operations and coordinate efforts to achieve goals
• Calculate impacts to clients, customers, and pharmacies using internal and external claims reports
• Submit impact documentation to matrix partners for financial remediation
• Maintain and update issue-tracking tickets in SharePoint
• Manage and coordinate remediation funding, including DMRs, P&L, and E&O
• Provide executive-level communications for escalated issues
• Analyze complex inquiries and determine the appropriate technical area or vendor for resolution

Lead Analyst, Enterprise Print & Distribution

• Lead assigned clinical operations programs and teams
• Provide operational leadership for Behavioral Health programs and workflows, including care coordination, referrals, and patient and provider support
• Design, implement, and manage clinical-program workflows, procedures, performance measures, escalation pathways, and operational controls
• Lead, mentor, and develop clinical and operational team members through coaching, performance management, goal setting, professional development, and accountability
• Collaborate with Behavioral Leaders, Nursing, Medical Affairs, Operations, Product, and Tech
• Identify root causes, eliminate unnecessary manual work, and develop sustainable solutions
• Establish, monitor, analyze, and report operational and clinical performance metrics
• Lead teams through new programs, technology changes, workflow redesigns, and organizational initiatives
• Provide leadership and decision support for complex patient, provider, and workflow escalations
• Ensure operations comply with organizational policies, clinical standards, regulatory and privacy requirements, and applicable best practices
• Support staffing, scheduling, workload management, and resource planning
• Develop and implement onboarding, training, job aids, procedures, and related resources
• Provide leadership during urgent operational events, system outages, and workflow disruptions
• Lead or participate in cross-functional initiatives and special projects

• Handle incoming calls from dental providers and reroute misdirected calls
• Take ownership of issues and resolve them over the phone with a “one and done philosophy”
• Research and interpret guidelines to respond to inquiries, complaints or disputes while ensuring compliance
• Conduct outreach to providers to obtain missing or additional information for compliant applications and contracts
• Collaborate with internal departments as needed
• Maintain positive relationships with health care professionals and office staff
• Assist with new provider or location credentialing, contracting and re-credentialing requests
• Respond to status requests and non-routine contract questions
• Assist with preparation or modification of provider compensation or contracts
• Complete work outputs to specified time and quality targets
• Prioritize own work and meet agreed timescales

RN Quality Specialist

Strategic Sales Support Advisor

Customer Service Representative

Behavioral Health Clinical Operations Manager

Senior Adoption Manager – Delivery Support, Insights

Claims & Provider Relations Advocate

Pharmacist, Home Infusion

Senior Adoption Manager – Delivery Support & Insights

Compensation & Recognition Analyst

RN, Bilingual Onsite Health Coach

Customer Service Representative

RN Onsite Health Coach

Lead Analyst, Enterprise Print & Distribution

Behavioral Health Clinical Operations Manager

Provider Contracting Associate Analyst