Business Operations Advisor

Cigna - Bloomfield, CT

Full-time - Mid Level

Hybrid - Bloomfield, CT

Insurance Carriers and Related Activities

About the position

The Business Operations Advisor at The Cigna Group plays a crucial role in managing complex IT support assignments and projects. This position involves relationship management with internal and external service providers, ensuring that IT components meet business service level agreements (SLAs). The advisor is responsible for maintaining processes and procedures related to IT services, including inventory management, contract negotiation, and compliance testing. The role requires a deep understanding of business operations, particularly in the healthcare sector, and involves providing thought leadership within IT Services while working on broader business initiatives.

Responsibilities

• Prepare and create test scenarios that match real life enrollment, fulfillment service, digital and migration processing.
• Participate in analysis of business processes to drive test workflows.
• Create and execute the testing of business process scenarios for all aspects of Medicare business including provider matching, provider fallout, member validation, enrollment, disenrollment, MOOP/OOP, benefit terms, Rules and Rates, procedure codes, appeals.
• Prepare compliance test cases reviewing compliance controls using samples from previous audit findings, CMS program audit, HIPAA guidelines, CMS reports etc.
• Create configuration test cases for product and benefit setup, COB, CMS mandates, EGWP, Service and procedure codes, Accumulators etc.
• Coordinate with Business SME and Business process optimization to understand various aspects of business requirements.
• Work with Test data and Test environment teams on deployment schedule for SERVICE READINESS VALIDATION (SRV) environment readiness for testing.
• Coordinate necessary access on tools/platforms to enable SERVICE READINESS VALIDATION (SRV) testing.
• Provide recommendations for Go/No Go release decisions.

Requirements

• Bachelor's degree preferred or equivalent experience.
• Five+ years of experience in Testing and Quality Engineering.
• Two+ years of experience in related business or healthcare experience.
• Strong claim processing understanding and advanced knowledge of health care coding, fee schedules, and reimbursement methodologies.
• Knowledgeable with high complexity, high volume transaction healthcare claim environment.
• Experience in Quality Engineering and/or Service Readiness Validation testing.
• Knowledge of data model/database design concepts and working knowledge of SQL is a plus.
• Experience in QNXT & Facets is preferred.
• Ability to work with shifting priorities to meet project requirements; self-motivated.
• Attention to detail, with strong analytical and problem-solving skills.
• Excellent written and oral communication skills.
• Experience working with multiple groups, both internally and externally - clients, engineering and product management teams.

Nice-to-haves

• Experience in healthcare IT systems and processes.
• Familiarity with compliance regulations in the healthcare industry.

Benefits

• Flexible work arrangements including remote work options.
• Health insurance coverage.
• Retirement savings plan options.
• Professional development opportunities.