Senior Specialist jobs at HCSC

Become a part of our caring community and help us put health first The Quality Improvement Professional 1 implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Quality Improvement Professional 1 work assignments are often straightforward and of moderate complexity. The Quality Improvement Professional supports quality improvement programs for all lines of business by gathering and analyzing data related to critical incidents including report generation and submission as required. Role Overview Work assignments are often straightforward and of moderate complexity. Monitors quality investigations and compliance processes. Partners with external entities in the market, Internal and Enterprise departments. May manage quality management system, department SharePoint, and department reporting. Audits processes as needed for compliance. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Use your skills to make an impact Required Qualifications Bachelor's degree Prior experience in a fast-paced insurance or health care setting 2+ years' experience in provider relations and education Understanding of healthcare quality measures STARS, HEDIS, etc. Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint Proven analytical skills Excellent communication skills, both oral and written Strong relationship building skills Must reside and perform work in the State of Michigan May travel to the Market office for meetings and/or training. May occasionally meet with Members or providers on an ad hoc basis. Preferred Qualifications Knowledge of Humana's internal policies, procedures and systems RN/LPN Nurse with quality experience Additional Information WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is required. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Additional Information Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Social Security Task Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $53,700 - $72,600 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Develop and conduct effective vendor oversight programs, in collaboration with key stakeholders, to assure vendor performance consistently meets regulatory requirements and internal business objectives Monitor vendor performance, including subsidiaries and external vendors, to assure performance is consistent with regulatory and business requirements Assure vendors have an effective self-monitoring programs that identify potential and/or actual performance issues Develop standardized processes for tracking and documenting all vendor oversight activities and reporting to key stakeholders Assure vendors develop, implement and complete corrective action plans to resolve identified deficiencies in compliance with regulatory and business requirements Serve as a subject matter expert.on current CMS requirements for operational functions and vendor oversight Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's degree in Healthcare, Business Administration or related field. 2+ years of combined managed care operations, compliance, auditing, project management, or business analysis experience, preferably within the Medicare field. Previous experience coordinating cross functional teams on large scale projects. Ability to evaluate, understand, and communicate regulatory and business requirements. Demonstrated understanding of relationships and dependencies between functional areas. This position is remote within the state of New York. Candidates must reside in the state of New York to be considered. Quarterly in office meetings required. Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. As a Revenue Cycle Subject Matter Expert (SME), you will be the strategic bridge between client operations and automation delivery-defining impactful use cases, facilitating solution-oriented discussions, and guiding process transformation. You'll lead discovery through shadowing sessions, document high-level success metrics, and ensure automation strategies align with client goals. With a solid presence in daily stand-ups, you'll approve technical documentation, resolve client-related issues, and provide critical process clarifications to keep automation initiatives moving forward with precision and purpose. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Collaborate with analysts to identify automation opportunities * Collaborate with architects and analysts on the team to translate identified business processes into automation opportunities * Engage with clients and executive leadership to present automation strategies, share insights, and facilitate solution-oriented discussions * Define use cases in collaboration with the client * Conduct shadowing sessions with various business process owners to understand current and future state processes * Document high-level use cases and success/ROI metrics * Approve Process Design Document (PDD) before bot development * Participate in daily stand-up meetings * Provide process clarifications * Resolve client-related issues during stand-ups You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 5+ years of hands-on experience in revenue cycle operations, with demonstrated expertise across front-end (e.g., patient access), mid-cycle (e.g., coding, documentation), and back-end (e.g., billing, collections) functions * 4+ years of experience supporting initiatives across front-end (e.g., patient access), mid-cycle (e.g., clinical documentation, coding), and back-end (e.g., billing, collections) operations * 3+ years of experience in a consulting or client-facing role, with a focus on delivering strategic process improvement and automation solutions in dynamic healthcare environments * 3+ years of experience in facilitating workshops, discovery sessions, and cross-functional meetings, leading to the identification and documentation of seven use cases and automation opportunities for clients * Experience presenting executive leadership, with the ability to distill complex operational challenges into strategic insights and ROI-driven recommendations-supported by at least five executive-level presentations * Experience having authored and validated high-level use cases, success metrics, and Process Design Documents (PDDs) for at least five automation initiatives, demonstrating rigorous documentation skills * Experience with resolving client-related issues in real time, with active participation in daily stand-ups and a history of supporting cross-functional delivery teams through process clarifications and issue resolution Preferred Qualifications: * Proven expertise in process redesign and systems implementation, driving operational efficiency and technology adoption * Hands-on proficiency with automation technologies, including Robotic Process Automation (RPA), Intelligent Document Processing (IDP), and workflow orchestration platforms such as UiPath, Automation Anywhere, or Power Automate * Leadership in cross-functional teams, fostering collaboration across business, technical, and operational stakeholders * Educational or professional background in engineering, providing a solid foundation in systems thinking and technical problem-solving * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** As a Revenue Cycle Subject Matter Expert (SME), you will be the strategic bridge between client operations and automation delivery-defining impactful use cases, facilitating solution-oriented discussions, and guiding process transformation. You'll lead discovery through shadowing sessions, document high-level success metrics, and ensure automation strategies align with client goals. With a solid presence in daily stand-ups, you'll approve technical documentation, resolve client-related issues, and provide critical process clarifications to keep automation initiatives moving forward with precision and purpose. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Collaborate with analysts to identify automation opportunities + Collaborate with architects and analysts on the team to translate identified business processes into automation opportunities + Engage with clients and executive leadership to present automation strategies, share insights, and facilitate solution-oriented discussions + Define use cases in collaboration with the client + Conduct shadowing sessions with various business process owners to understand current and future state processes + Document high-level use cases and success/ROI metrics + Approve Process Design Document (PDD) before bot development + Participate in daily stand-up meetings + Provide process clarifications + Resolve client-related issues during stand-ups You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + 5+ years of hands-on experience in revenue cycle operations, with demonstrated expertise across front-end (e.g., patient access), mid-cycle (e.g., coding, documentation), and back-end (e.g., billing, collections) functions + 4+ years of experience supporting initiatives across front-end (e.g., patient access), mid-cycle (e.g., clinical documentation, coding), and back-end (e.g., billing, collections) operations + 3+ years of experience in a consulting or client-facing role, with a focus on delivering strategic process improvement and automation solutions in dynamic healthcare environments + 3+ years of experience in facilitating workshops, discovery sessions, and cross-functional meetings, leading to the identification and documentation of seven use cases and automation opportunities for clients + Experience presenting executive leadership, with the ability to distill complex operational challenges into strategic insights and ROI-driven recommendations-supported by at least five executive-level presentations + Experience having authored and validated high-level use cases, success metrics, and Process Design Documents (PDDs) for at least five automation initiatives, demonstrating rigorous documentation skills + Experience with resolving client-related issues in real time, with active participation in daily stand-ups and a history of supporting cross-functional delivery teams through process clarifications and issue resolution **Preferred Qualifications:** + Proven expertise in process redesign and systems implementation, driving operational efficiency and technology adoption + Hands-on proficiency with automation technologies, including Robotic Process Automation (RPA), Intelligent Document Processing (IDP), and workflow orchestration platforms such as UiPath, Automation Anywhere, or Power Automate + Leadership in cross-functional teams, fostering collaboration across business, technical, and operational stakeholders + Educational or professional background in engineering, providing a solid foundation in systems thinking and technical problem-solving *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Data and Analytics Engineering at Cigna is looking for a strong software engineer who can solve complex problems, inspire other engineering talent, and deliver business capabilities that improve access to high performing providers and increase healthcare affordability. This role is the perfect blend of software development, data engineering, business analytics, and delivery execution. It is a great opportunity for someone who wants to be challenged, drive change, and deliver value that is tangible. You will drive design, and develop applications that provide Cigna with competitive analytics and intelligence used to create more cost effective products, increase member affordability, and optimize market growth strategies. You will have the opportunity to design, develop, and deploy new applications and features that will directly impact and drive Cigna's competitive decisions within the marketplace, and ultimately provide better and more affordable healthcare. Cigna uses a variety of technologies, from big data to the latest web frameworks. You will get to build state-of-the-art technology that is scalable and robust, utilizing cloud infrastructure, and full automation. Core responsibilities: As a lead software engineer, you will help develop an integrated solution strategy to support next-generation reporting and analytical capabilities on an enterprise-wide scale. You will deliver user-oriented products in a fast-paced and agile environment. Data and analytical capabilities and architecture Developing rock-solid, scalable systems Drive opportunities to revolutionize workflow with embedded analytics, machine learning, and AI Enforce modern delivery practices such as continuous integration, behavior/test driven development Ideal Candidates Will Offer: Attributes: LOVES data, analytics, building self-service tools and web application platforms using the latest technologies Solid managerial and/or mentorship experience Boundless intellectual curiosity to continually explore how to do things better, bigger, faster and cheaper A strong voice for data integrity and reporting quality utilizing best practices and industry standards A “roll-up your sleeves and get the job done” mentality Enjoys speaking with customers to understand how we can best meet their needs Team player and motivator who inspires, embraces diversity of thought, and fosters a culture of creativity Requirements: 5+ years of experience in software development Extensive experience in modern web development frameworks: React, Angular, Node.js, Django, etc. Extensive experience with a scripting language: Javascript, Python, Ruby, Perl, etc. Extensive experience with an object oriented language: C++, Java, Scala, or other OO compiled language Data mining and SQL experience Familiarity with Visualization Libraries: D3, Shiny, Tableau, etc. Knowledge and experience with agile development process Bachelor's or Master's degree in Computer Science or equivalent in education and 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. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

We are seeking a self-motivated business analytics or actuarial professional with a passion for problem solving and a strong desire to learn, lead and innovate to join our growing team. This role will work collaboratively with Network Analytics, Contracting, Competitive Intelligence, IT, and other matrix partners to support our uniform data submissions (UDS) and workstreams. This individual should be an inquisitive learner and a strong team player who enjoys working in a dynamic environment. The Uniform Data Submission (UDS) team supports Cigna's semi-annual discount submission and annual risk adjusted PMPM submission to consultants, who then use the information to evaluate carriers for both prospective and existing client RFP's. The UDS information is also used for several internal processes including competitive benchmarking and setting discount or trend guarantees. The candidate will lead the exploration and implementation of data quality strategies and improved capabilities. This will include partnering with internal stakeholders to identify opportunity areas, researching and exploring opportunities for potential changes to our submission/process, conducting detailed data analysis and testing, translating results into recommendations, and providing communication and support to internal and external stakeholders. Responsibilities Provide analytical and strategic support to Cigna's UDS Discount & Risk Adjusted PMPM submissions Identify opportunities to improve our UDS submissions, lead action plan development, and drive execution Partner with internal stakeholders to better understand Cigna claim systems, programs, and initiatives to identify opportunity areas and innovate new capabilities Develop and maintain a tracking tool to capture all opportunities and ideas to improve the quality and effectiveness of our UDS submissions, including broker specific ideas Lead detailed testing of and assess the impact of all potential changes to the UDS submissions including instituting data validation and documentation processes for all changes Analyze results and present findings and recommendations to business partners at various levels of the organization Review tools and reports available to matrix partners (Network Analytics, Competitive Intelligence, Contracting, Pricing and Market Actuaries), gather feedback on current gaps, and lead efforts to update/overhaul current toolset to be more accurate, interactive, and user-friendly Support the development and execution of various stakeholder reporting needs (e.g., C/I's Cost Access process, Pricings Translation Factor setting process) Support business partners and team members on an ad hoc basis as needed to support various integral business needs (e.g., Underwriting Discount Guarantee support, Network Analytics/Med Econ review process) Assist in the development of uniform data submissions (discounts and risk adjusted PMPM), reports, models and tools Assist in the education and training of new team members Maintain strong communication with other analysts to identify new opportunities and share best practices Qualifications 5+ years' experience in healthcare analytics, finance, data analysis, or actuarial functions leveraging data analytics to drive business decisions Technical sophistication with various data mining and business intelligence tools such as SAS and/or SQL and advanced Microsoft Excel skills, experience with Databricks and GitHub a plus Knowledge of Cigna claims systems and/or standard medical coding including CPT-IV, ICD-10, DRG, revenue codes, and HCPCS strongly preferred Strong analytical and problem-solving skills with a proven track record of success Ability to independently perform data analysis while managing multiple projects and meeting strict deadlines Highly organized and detail-oriented, with strong project management and documentation skills Strong ability to validate and interpret results Strong verbal/written communication and leadership skills to work with various matrix partners 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 109,500 - 182,500 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 The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Step into your next big career move as one of our compliance champions! With your strong background in claims processing, you'll play a pivotal role in monitoring Medicare Advantage Part C and D claims to ensure accuracy, integrity, and compliance across the board. Our Senior Ethics & Compliance Specialist role is where expertise meets purpose - you'll be safeguarding processes, supporting quality care, and driving excellence in one of the most impactful areas of healthcare. For seasoned claims professionals, this is more than a job; it's a chance to lead with confidence, champion compliance and make a meaningful difference every single day. Note: This is a fully remote role, but local candidates are preferred as travel to our Chattanooga, TN headquarters is expected once or twice per quarter. Job Responsibilities Interpreting and disseminating regulatory, compliance and contractual requirements for operational business functions. Monitoring and reviewing organizational procedures and policies to update compliance requirements. Leading the areas compliance program with the implementation of the approved monitoring workplan. Analyzing compliance issues, and providing solutions on regulatory, contractual, and compliance issues. Creating smooth cross departmental communication channels about ethics and compliance issues and solutions. Job Qualifications Education Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment Experience 5 years - Operations and/or Compliance experience required Skills\Certifications Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. Demonstrated ability to interpret and translate regulatory and/or complex concepts into information meaningful to project team members and/or business personnel. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment Must be a team player, be organized and have the ability to handle multiple projects Excellent oral and written communication skills Strong interpersonal and organizational skills Proven decision making and problem solving skills Strong analytical skills . Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

This is a management position where the candidate should have documented development experience in communication systems that involve Customer Data Platform (CDP) and Content Management System (CMS) technologies. This person will have an extensive background in managing a team focused on developing emails, SMS, and Push communications, pushing content live using the known SaaS technologies, as well as significant time working with engineers, designers, writers and HTML coders to implement said technologies. In this role, the individual works across multiple teams, and it is essential for this person to work collaboratively. Excellent communication and leadership skills are a must. Ideal candidate will be a hands-on, results-oriented, team player with the ability to collaborate cross-functionally and perform well in a fast-paced environment on multiple challenging projects at a time. Previous experience with a CDP platform and agile IT methodology is required. Key Responsibilities will include: Manage a team of up to 5 developers working in the RedPoint CDP environment. Develop and design emails with technologies like XSL, XSLT, XML, CSS, DHTML, JSON, core Java Freemarker and/or software tools like Litmus, Email on Acid, and XML Spy. Some database knowledge. Support maintenance and management of campaign & transactional based email templates, including optimization of existing programs through testing. Support technology enhancements for new and existing communication programs. Includes close collaboration with product and campaign teams to map data driving dynamic and personalized content. QA and test emails across different browsers, devices and desktop clients Work with IT and architecture teams to stand up and implement the necessary tools for comms management. Participate in IT intake and Agile process to manage portfolio of projects and prioritize appropriately. Manage prioritization calendar for owned projects and adjust accordingly based on Enterprise goals and objectives. Oversee A/B testing of email creative, subject lines, date/time, list segments, etc. and communicate recommendations effectively. Participate in daily, weekly team and Agile meetings as needed. Provide status updates to cross functional teams and management. What skills will make you successful? Experience working in and managing a team working in a CDP, RedPoint RPI experience a big plus Knowledge of SaaS email platforms such as Salesforce, Epsilon, Cheetah Digital Marketing Suite is a plus. A solid understanding of email platform functionality, data integrations/APIs, CAN-SPAM and CASL compliance, email metrics, email deliverability, and email best practices; knowledge of major email service providers, web analytics tools and content management solutions, such as Contentful, Drupal and Alfresco. Ability to manage multiple direct reports and projects simultaneously without compromising quality, timelines or attention to detail Demonstrates a sense of urgency Exhibits a curious, positive, team-oriented, enthusiastic approach Ability to work under extreme pressure and strict timelines, and to thrive in a fast-paced environment What is required for you to apply? Bachelor's degree in computer science, engineering, or similar field of study Minimum 5-7 years in technical experience including 2-3 years in management Experience with a Customer Data Platform (CDP), preferably RedPoint Advanced knowledge of html and data driven, dynamic creative Knowledge of Adobe Analytics platforms or similar reporting tools. 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 116,800 - 194,600 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 The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Legal Compliance Sr. Advisor - Commercial As a senior individual contributor within EviCore's Commercial Compliance department, this role is pivotal in shaping and executing the organization's compliance strategy. The position operates cross-functionally with Compliance, Legal, Government Affairs, and business stakeholders, ensuring robust Commercial compliance programs and adherence to applicable state and federal regulations, as well as accreditation requirements. Key Responsibilities Serve as the recognized Commercial Compliance subject matter expert (SME), providing advanced regulatory and reporting guidance to internal stakeholders Lead and support second line of defense audits, identifying and reporting areas of non-compliance and risk, and ensuring effective preventative measures are in place Deliver day-to-day Commercial guidance and timely notifications on updated contracts and regulations Identify and analyze Commercial regulatory compliance trends and risks, leveraging data and engagement to inform leadership Participate in client regulatory audits to observe and provide Commercial regulatory guidance Advise functional leaders and contribute thought leadership within Compliance, while engaging in broader projects that require a deep understanding of the business Key presenter in EviCore's regulatory and new law oversight committees Qualifications Bachelor's degree required. Juris Doctor (JD), master's in health-related field, or paralegal certificate preferred 7+years of experience in the healthcare industry with a focus on healthcare utilization management Demonstrated expertise in interpreting and implementing healthcare-related state and federal laws and regulations Proven ability to engage strategically with legal and business resources to ensure accurate and effective application of law and regulation Experience developing and leveraging processes for tracking, coordinating, and collaborating on health plan and hospital system audits, monitoring, and corrective actions Strong analytical, problem-solving, and communication skills, with the ability to manage multiple projects to timely completion Ability to work collaboratively and foster strong relationships in a large, matrixed organization Independent decision-making capability Proficiency in Microsoft Word, Outlook, PowerPoint, and Excel Knowledge of Smartsheet and Adobe (PDF) applications is preferred 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 108,500 - 180,900 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 Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. REMOTE ROLE: Must reside in Arizona Non clinical quality improvement specialist role will evaluate data provided in Excel format and write technical reports. State Contract, Medicaid knowledge preferred. Position Purpose: Support the development and maintenance of quality improvement related projects and reporting. Respond to quality improvement inquiries. Heavy chart monitoring and auditing of medical records Monitor the production of quality results reporting; analyze, track and trend the reporting results and report them to management Formulate and prepare ad-hoc and additional reporting requirements Recommend, develop, and implement quality improvement plans with management Train providers and staff in methodologies and tools of continuous quality improvement Prepare for and participate in meetings with State agencies, providers, and stakeholders Perform audits on to meet state and internal requirements Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor's degree in related field or equivalent experience. Certified Professional in Healthcare Quality (CPHQ) preferred. 3+ years of related experience. License/Certification: Valid driver's license. Certified Professional in Health Care Quality (CPHQ) preferred.Pay Range: $55,100.00 - $99,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. ***POSITION IS REMOTE BUT IDEAL CANDIDATE WILL RESIDE IN MISSOURI, IOWA OR ILLINOIS AND HAVE MANAGED CARE PROCESS IMPROVEMENT EXPERIENCE*** Position Purpose: Support the data management and quality improvement initiatives for assigned functional areas Assist with the development and coordination of all core health services data reports Support the development of quality improvement performance audit function processes and tools Assist in designing, running, managing, and data review process for assuring accuracy and integrity of health services data reports to meet regulatory and operational requirements Report outcomes and quality monitoring results to management Assist with managing databases, policies and procedures related to assigned areas Assist with related activities for various committees and meetings for assigned areas Education/Experience: Associate's degree in related area or equivalent experience. 2+ years of data management, including reporting, project management or quality improvement experience.Pay Range: $22.79 - $38.84 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

We are looking for an accomplished Senior Full Stack Software Engineer with deep expertise in Angular for frontend development and strong backend proficiency in Node.js. The ideal candidate will be highly skilled in TypeScript, experienced with AWS, and well-versed in CI/CD pipelines, DevOps practices, and SQL databases. In this role, you will be instrumental in designing and delivering scalable, resilient, and fault-tolerant systems that power our next-generation applications. Key Responsibilities Lead the design and development of responsive, high-performance web applications using Angular and TypeScript. Architect and maintain scalable backend services with Node.js, emphasizing fault tolerance and resilience. Collaborate with cross-functional teams to define requirements, design solutions, and deliver new features. Implement and manage CI/CD pipelines and DevOps workflows to ensure efficient deployment and operations. Deploy and manage applications on AWS cloud infrastructure. Design and optimize relational databases using SQL for performance and scalability. Uphold code quality through unit testing, integration testing, and rigorous code reviews. Mentor junior engineers and provide technical leadership within the team. Required Qualifications 5+ years of professional software development experience. Advanced proficiency in Angular (v12+) and TypeScript. Strong backend development experience with Node.js. Hands-on experience with AWS services (e.g., Lambda, EC2, S3, RDS, CloudFormation). Familiarity with CI/CD tools (e.g., Jenkins, GitHub Actions, GitLab CI) and DevOps best practices. Solid understanding of SQL and relational database design. Proven ability to build resilient and fault-tolerant systems. Excellent problem-solving skills and attention to detail. Strong communication and collaboration abilities. Preferred Qualifications Experience with other frontend frameworks (e.g., React, Vue). Knowledge of NoSQL databases (e.g., DynamoDB, MongoDB). Familiarity with containerization technologies (Docker, Kubernetes). 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 127,400 - 212,300 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 The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The Nurse Informaticist applies advanced clinical expertise and informatics knowledge to drive quality improvement initiatives through data-driven strategies. This role is responsible for optimizing clinical workflows, enhancing patient care, and ensuring regulatory compliance by utilizing evidence-based data analysis and digital data acquisition methods. Within Cigna, this position contributes to clinical quality efforts by leading projects that leverage data to inform improvements in both clinical and operational practices. The role is essential in maintaining compliance with external accreditation and regulatory requirements via sophisticated data analysis and comprehensive reporting. As Cigna shifts from traditional HEDIS measurement to digital quality assessment, the Nurse Informaticist will be pivotal in modifying methodologies, implementing new tools, and updating strategies to meet changing industry standards and technological advancements. Key Responsibilities: HEDIS & Clinical Data Analysis Oversee HEDIS data collection, reporting, and analysis for assigned regions and projects. Evaluate clinical initiative outcomes to identify improvement opportunities across diverse populations, including clients, CACs, commercial markets, and IFP programs. Conduct both statistical and qualitative analyses utilizing claims, pharmacy, laboratory, and demographic data sources. Facilitate the transition to digital quality measurement by adapting data workflows, analytical tools, and reporting methodologies. Clinical Integration Connect clinical practice with data analytics to inform evidence-based care enhancements. Partner with nursing and clinical teams to transform data-driven insights into practical protocols. Clinical Systems Leadership Lead the design, implementation, and optimization of clinical information systems, such as EHRs and digital quality measurement platforms. Act as a subject matter expert in clinical data standards, interoperability, and digital health initiatives. Advanced Quality Measurement Direct the shift from traditional to digital quality measurement methods, ensuring alignment with best clinical practices. Develop and validate clinical quality metrics that accurately represent real-world patient outcomes. Measurement & Reporting Establish measurement strategies and create scorecards and reports to support: External accreditation Population health advancement Regulatory compliance Performance monitoring Project Leadership & Technical Guidance Manage time-sensitive projects and deliverables within larger strategic initiatives. Provide technical leadership and guidance to quality teams regarding system requirements and data solutions. Process Improvement & Efficiency Identify and implement opportunities to optimize analytic processes and reduce operational costs. Design and maintain tools for tracking and forecasting HEDIS performance metrics. Stakeholder Engagement Collaborate with internal cross-functional teams and external partners to advance personalization and localization objectives. Coordinate with state immunization registries and other external organizations for data submissions. Experience: Minimum of 8-10 years of clinical nursing experience, with at least 3-5 years in informatics or clinical data analytics roles. Proven leadership in clinical informatics initiatives, such as EHR implementation, digital quality measurement, and workflow redesign. Previous experience with HEDIS and digital quality programs is preferred. Technical Skills: Advanced proficiency with EHR systems, clinical data standards (HL7, FHIR), and analytics tools. Experience utilizing SQL, Tableau, PowerBI, and healthcare interoperability solutions. Proficiency in MS Access and MS Excel. Certifications: Nursing Informatics Certification is preferred. Education A valid Registered Nurse (RN) license is required. A Master's degree in Nursing Informatics, Health Informatics, or a closely related discipline is strongly preferred. Other Qualifications: Strong project management, communication, and change leadership skills. Excellent analytical, problem-solving, and presentation capabilities. Demonstrated customer-centric approach with the ability to collaborate effectively within a matrixed environment. 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 109,500 - 182,500 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 The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The job profile for this position is Architecture Senior Advisor, which is a Band 4 Contributor Career Track Role with Cigna-Evernorth Services Inc. Responsibilities- Conduct internal client assessments which include as-is, to-be, gap analysis phased technology plans, project plans, and audit documentation. Responsible for identifying gaps and issues, recommending areas of opportunity, determining potential timing of improvement initiatives, and defining the costs and benefits of proposed solutions. Act as a technology partner between the Contact Center Business Leadership and Technology teams to aid in planning, coordinating, and directing the delivery of highly complex business solutions to meet Contact Center needs. Actively govern the IT elements of the project through its life cycle, ensuring the delivered solution is aligned with architecture and standards. Utilize Contact Center systems such as Contact Routing, CTI, Automatic Call Distribution (ACD), Interactive Voice Response (IVR), Call Recording, Workforce Management, and Quality Assurance for multi-channel contact management of voice, email, chat, SMS messaging, etc. Provide guidance, thought leadership and operational support for internal and external customers. Provide development of strategic designs. Conduct iterative reviews and revisions of design documentation. Drive large contact center projects from an architecture and design perspective including call routing, multi-platform contact centers, inbound/outbound self-service/queuing and applications, agent desktop, courtesy callback, IVR, and deployment approach. May work remotely. Qualifications- Requires Bachelor's degree or foreign equivalent in Computer Science, Computer Engineering, or a closely related field and 7 years of IT experience. Must have experience with: Dell Boomi; Glue; Kong; Amazon AWS API; HTML5; CSS3; JavaScript; Bootstrap; jQuery; LESS; Angular; ReactJS; C#; .Net; MySQL; MongoDB; SQL Server; AWS; Azure; GitHub; Jenkins; GitLab; Confluence Documentation; SharePoint Documentation; Security Designs and Documentation; API (REST & SOAP); Twilio; managing healthcare project standards; HIPPA compliance norms; and reviewing Business Associate Agreement (“BAA”) documents. 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. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The job profile for this position is Architecture Senior Advisor, which is a Band 4 Contributor Career Track Role with Cigna-Evernorth Services Inc. Responsibilities- * Conduct internal client assessments which include as-is, to-be, gap analysis phased technology plans, project plans, and audit documentation. * Responsible for identifying gaps and issues, recommending areas of opportunity, determining potential timing of improvement initiatives, and defining the costs and benefits of proposed solutions. * Act as a technology partner between the Contact Center Business Leadership and Technology teams to aid in planning, coordinating, and directing the delivery of highly complex business solutions to meet Contact Center needs. * Actively govern the IT elements of the project through its life cycle, ensuring the delivered solution is aligned with architecture and standards. * Utilize Contact Center systems such as Contact Routing, CTI, Automatic Call Distribution (ACD), Interactive Voice Response (IVR), Call Recording, Workforce Management, and Quality Assurance for multi-channel contact management of voice, email, chat, SMS messaging, etc. * Provide guidance, thought leadership and operational support for internal and external customers. Provide development of strategic designs. * Conduct iterative reviews and revisions of design documentation. * Drive large contact center projects from an architecture and design perspective including call routing, multi-platform contact centers, inbound/outbound self-service/queuing and applications, agent desktop, courtesy callback, IVR, and deployment approach. * May work remotely. Qualifications- Requires Bachelor's degree or foreign equivalent in Computer Science, Computer Engineering, or a closely related field and 7 years of IT experience. Must have experience with: Dell Boomi; Glue; Kong; Amazon AWS API; HTML5; CSS3; JavaScript; Bootstrap; jQuery; LESS; Angular; ReactJS; C#; .Net; MySQL; MongoDB; SQL Server; AWS; Azure; GitHub; Jenkins; GitLab; Confluence Documentation; SharePoint Documentation; Security Designs and Documentation; API (REST & SOAP); Twilio; managing healthcare project standards; HIPPA compliance norms; and reviewing Business Associate Agreement ("BAA") documents. 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. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: ********************* for support. Do not email ********************* 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

The Evernorth Strategic Initiatives team functions as an internal consulting organization and provides broad support on senior-leader sponsored and high-impact/cross-functional programs across Evernorth. The Strategic Initiatives Senior Advisor will support the management of various consulting engagements in a variety of ways which may involve providing content/idea creation, working cross-functionally, and developing and managing strategic project and communication plans (written and verbal). **More specifically, the individual selected for this role will be responsible for:** + Supporting large (and sometimes leading less complex) cross-functional strategic initiatives: aligning charters/objectives, developing and executing program plans, metrics and timelines, managing and/or monitoring progress to execution. + Preparing for and leading program workstream meetings, proactively ensuring action items are tracked and followed up on. + Coordinating, preparing, and at times delivering executive leadership program updates. + Engaging in a variety of business support functions ranging from project/program management, to data analysis and financial modeling. + Analyzing complex situations, distilling the issues into strategic options and driving to appropriate conclusions. + Tactfully managing tight deadlines, scope, and converging opinions to solutions. + Ensuring projects deliver business operational needs, requirements, and value. + Developing and driving detailed communication plans, schedules, projected estimates, and resource plans. + Handling high-pressure environments with multiple competing priorities. + Flexing to accommodate for evolving program and business needs. + Staying informed of the changing healthcare landscape in order to provide relevant enterprise strategy guidance. **Job Requirements Include:** + 7+ years of relevant professional experience (healthcare, pharmacy, PBM, consulting, finance) highly preferred + Bachelor's Degree highly preferred; Master's Degree a plus + Exceptional project management skills and strong financial acumen + Interest and ability in solving problems, bringing teams together to resolve challenges, driving process improvements, leading expense reduction or margin driving initiatives + Ability to manage complex analysis from issue identification to proposal of potential solutions + Superb oral and written communication skills with a proven ability to communicate complex concepts to stakeholders at all levels of the organization + Excellent interpersonal skills and proven ability to perform in a matrix environment + Strong ability to work autonomously and deal with ambiguity + Ability to manage change, timelines and balance multiple deadlines in a fast-paced environment + Advanced experience with Microsoft Office applications including Excel, Powerpoint, Word, and Visio + Ability to be flexible as priorities change, new areas have needs, or team capacity dictates + May require travel up to 15% 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 109,600 - 182,600 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 The Cigna Group** Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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:_ _*********************_ _for support. Do not email_ _*********************_ _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._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. This position is a Medicaid Subject Matter (SME) Expert for the Enterprise Data Warehouse supporting the State Medicaid program. This role requires significant expertise of Medicaid Enterprise System modules and data warehousing or decision support systems. This role provides the guidance and direction to support a large data warehouse implementation and maintenance & operations. The selected SME will provide the required decisions for the business and technical team members to modify, change, enhance or correct within the system, related to claims, provider, and recipient data. Roles in this function will partner with stakeholders to understand data requirements and support development tools and models such as interfaces, dashboards, data visualizations, decision aids and business case analysis to support the organization. Additional roles include producing and managing the delivery of activity, value analytics and critical deliverables to external stakeholders and clients. This is a telecommute position with some ( You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: * Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations * With the specialized knowledge of the Medicaid and Children's Health Insurance Programs (CHIP), lead and guide internal and external stakeholders to make determinations relating to complex processes involving claims processing/adjudication, recipient eligibility, provider enrollment, and third-party liability * Proactively identify and understand state Medicaid agency data needs and determines the recommended solution to meet them with credible reason, justification and validated proof of concepts * Direct technical and business teams on healthcare topics understanding and utilizing healthcare data appropriately * Proactively suggest and recommend enhancements and improvements throughout the project processes, driven by Medicaid best practices, standards and policies You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 10+ years of experience in information technology with 5+ years of experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing business requirements and testing/validation of various systems * 2+ years of experience working CMS Federal Reporting MARS, PERM, T-MSIS, Quality of Care CMS Core Measure or similar projects * Knowledge of the Centers for Medicare and Medicaid Services reporting requirements and the programs covered * Understanding of claims, recipient/eligibility, and provider/enrollment data processes * Proven ability to create and perform data analysis using SQL, Excel against data warehouses utilizing large datasets * Proven excellent verbal/written communication and presentation skills, manager/executive/director-level client facing, team collaboration, and mentoring skills * Proven solid culture fit, demonstrating our culture values in action (Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance) * Ability to travel to Springfield, IL two (3) to three (4) times per year or as needed Note: Core customer business hours to conduct work is M-F 8 AM - 5 PM CST. Preferred Qualifications: * 2+ years of experience in HEDIS, CHIPRA or similar quality metrics * Experience with data analysis using Teradata Database Management System or other equivalent database management system * Experience using JIRA, Rally, DevOps or equivalent * Experience in large implementation or DDI project * Located within driving distance (3 - 5 Hours) of Springfield, IL * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** This position is a Medicaid Subject Matter (SME) Expert for the Enterprise Data Warehouse supporting the State Medicaid program. This role requires significant expertise of Medicaid Enterprise System modules and data warehousing or decision support systems. This role provides the guidance and direction to support a large data warehouse implementation and maintenance & operations. The selected SME will provide the required decisions for the business and technical team members to modify, change, enhance or correct within the system, related to claims, provider, and recipient data. Roles in this function will partner with stakeholders to understand data requirements and support development tools and models such as interfaces, dashboards, data visualizations, decision aids and business case analysis to support the organization. Additional roles include producing and managing the delivery of activity, value analytics and critical deliverables to external stakeholders and clients. This is a telecommute position with some ( You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. **Primary Responsibilities:** + Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations + With the specialized knowledge of the Medicaid and Children's Health Insurance Programs (CHIP), lead and guide internal and external stakeholders to make determinations relating to complex processes involving claims processing/adjudication, recipient eligibility, provider enrollment, and third-party liability + Proactively identify and understand state Medicaid agency data needs and determines the recommended solution to meet them with credible reason, justification and validated proof of concepts + Direct technical and business teams on healthcare topics understanding and utilizing healthcare data appropriately + Proactively suggest and recommend enhancements and improvements throughout the project processes, driven by Medicaid best practices, standards and policies You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + 10+ years of experience in information technology with 5+ years of experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing business requirements and testing/validation of various systems + 2+ years of experience working CMS Federal Reporting MARS, PERM, T-MSIS, Quality of Care CMS Core Measure or similar projects + Knowledge of the Centers for Medicare and Medicaid Services reporting requirements and the programs covered + Understanding of claims, recipient/eligibility, and provider/enrollment data processes + Proven ability to create and perform data analysis using SQL, Excel against data warehouses utilizing large datasets + Proven excellent verbal/written communication and presentation skills, manager/executive/director-level client facing, team collaboration, and mentoring skills + Proven solid culture fit, demonstrating our culture values in action (Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance) + Ability to travel to Springfield, IL two (3) to three (4) times per year or as needed **Note:** Core customer business hours to conduct work is M-F 8 AM - 5 PM CST. **Preferred Qualifications:** + 2+ years of experience in HEDIS, CHIPRA or similar quality metrics + Experience with data analysis using Teradata Database Management System or other equivalent database management system + Experience using JIRA, Rally, DevOps or equivalent + Experience in large implementation or DDI project + Located within driving distance (3 - 5 Hours) of Springfield, IL *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. *****POSITION IS REMOTE BUT IDEAL CANDIDATE WILL RESIDE IN MISSOURI, IOWA OR ILLINOIS AND HAVE MANAGED CARE PROCESS IMPROVEMENT EXPERIENCE***** **Position Purpose:** Support the data management and quality improvement initiatives for assigned functional areas + Assist with the development and coordination of all core health services data reports + Support the development of quality improvement performance audit function processes and tools + Assist in designing, running, managing, and data review process for assuring accuracy and integrity of health services data reports to meet regulatory and operational requirements + Report outcomes and quality monitoring results to management + Assist with managing databases, policies and procedures related to assigned areas + Assist with related activities for various committees and meetings for assigned areas **Education/Experience:** Associate's degree in related area or equivalent experience. 2+ years of data management, including reporting, project management or quality improvement experience.Pay Range: $22.79 - $38.84 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act