Operations Lead Analyst -IFP Enrollment and Reconciliation- Cigna Healthcare- Hybrid at Cigna in Bloomfield, Connecticut

Job Description:

Job Summary:

Be part of a small team that leads and supports enrollment processing and reconciliation efforts for Individual and Family Plan segment, including overseeing integration with Federal and State Healthcare Marketplaces, private exchanges, and third party administrators. Guarantee that the Medical and Dental customers that we have the privilege to serve have access to the care they need on their coverage effective date. Ensure that their enrollment information is accurate and consistent across all systems in the care delivery and support value chains, so Cigna can deliver the optimal customer experience and achieve our growth and profitability targets. Drive continuous improvement and support the future of Cigna's Individual and Family Plans with technical and process subject matter expertise.

Core Responsibilities:

• Develop technical and process subject matter expertise on the end to end enrollment systems and processes.


• Act as Enrollment systems and process subject matter expert in support of team, segment and enterprise initiatives.


• Maintain a current knowledge of all federal or state specific regulations and sub-regulatory guidance as it relates to Federally Facilitated or State Based individual insurance exchanges and reconciliation programs.


• Ensure compliance with all federal and state regulations.


• Develop and maintain critical documents including policies, standard operating procedures, business rules, and technical specifications.


• Oversee internal and external matrix partners' execution of our enrollment process including the development, maintenance, and reporting of key performance indicators and service level agreements.


• Manage, support, and drive continuous improvement of the enrollment process, and issue/defect resolution processes.


• Work with third party administrator and key matrix partners to create and implement end to end data analysis, reconciliation, and discrepancy resolution processes for enrollment data.


• Support daily, weekly, and monthly reconciliation efforts across multiple internal and external matrix partners and systems including researching and resolving transactional errors.


• Partner with enrollment and billing vendor and Federal/State marketplaces to analyze and understand all enrollment discrepancies uncovered during the monthly reconciliation process between the Healthcare Marketplace and Cigna/Cigna's TPA


• Deliver accurate and timely daily, weekly, and monthly reporting as required.


• Communicate the status of enrollment processing and/or reconciliation efforts, including all remediation efforts to cross functional matrix partners and leadership.


• Partners with operational and information technology teams to influence, develop and implement technology and business processes that enable operational oversight of enrollment process, reduces operational costs, ensures data consistency and availability to all key stakeholders, support growth scalability, and enables corporate or statutory audits.


• Use data based analysis to prioritize and drive decreased disjoint metrics, and increased operational efficiency.

Minimum Qualifications:

• Good analytical and problem solving skills


• Health Care background (Benefits, Eligibility, Claims subject areas) required


• Ability to work with Matrix Partners and Vendors (HPS, Colibrium) highly desired


• Strong written and verbal communication skills


• Strong organizational and interpersonal skills


• Strong critical thinking skills with the ability to identify the root cause of a problem as well as potential peripheral impacts.


• Strong influencing and matrix management skills preferred


• Self-motivated learner with the ability to learn on the fly


• Ability to work independently and in conjunction with co-workers of all levels


• Ability to create and implement contingency plans and solutions for problems that arise


• Demonstrated ability to drive results required


• Comfortable with raising questions, issues, ideas or suggestions to co-workers of all levels across all organizations


• Act with a sense of urgency to research questions or issues brought by the team


• Proficiency with Microsoft products including: Excel, Word, Power Point and Outlook


• Experience with relational databases and XML preferred.


• Experience using SQL preferred.


• Knowledge of MS Access DataBase preferred.


• Bachelor's degree or equivalent experience required.


• At least 2-3 years of Healthcare insurance business experience

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 58,100 - 96,900 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.