Operations Advisor - Remote

Position Summary

This role supports new and evolving programs within the Reimbursement Capitation and Collaboration Operations (RCO) team. RCO ensures accurate and timely payments to groups, hospital systems, vendors, and partners that support capitation and value-based strategies.

The role focuses on payment processing, contract setup, reporting, data review, and issue resolution across multiple systems. You will analyze payment results, understand financial impacts, and support a fast-changing environment.

Key Responsibilities

• Execute monthly, quarterly, and annual payment activities, ensuring files balance with no unresolved issues
• Configure payment and contract details in payment systems using actuarial, underwriting, and contract data
• Investigate data issues, resolve payment fallout, and support inventory control
• Develop, refine, and standardize operational, financial, and vendor reporting
• Track and summarize payment activity, trends, and outliers for performance monitoring
• Partner with Sales, Marketing, Contracting, Product, and other teams to plan and support payment needs
• Identify process gaps, and implement process improvements
• Partner with teams and matrix stakeholders to execute RCO plans, evaluate outcomes, and drive short‑term actions and long‑term solutions
• Support compliance audits and legal requests as needed
• Balance short-term fixes with long-term process improvements

Qualifications

• High School Diploma or GED required. Bachelor’s degree preferred
• 4+ years of experience with value-based or non-fee-for-service payment processing strongly preferred
• 5+ years of healthcare payment or claims data experience preferred
• Experience with reporting tools such as Toad, Databricks, or SAS preferred
• Knowledge of capitation and/or value-based payment concepts, processes and systems such as CCMI, and PMHS capitation highly preferred
• Strong Excel and PowerPoint skills
• Ability to work independently and with cross-functional partners
• Proven ability to manage multiple priorities in a changing environment
• Strong analytical, problem-solving, and communication skills
• Ability to translate business needs into operational solutions
• Experience improving processes, automation, and reporting
• Knowledge of Cigna payment systems is a plus
• Interest in building AI knowledge

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 82,400 - 137,300 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.

At The Cigna Group, 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), 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, click here.

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.