Medicare Advantage Provider Directory Operations and Accuracy Senior Manager - Cigna Healthcare - Remote

Cigna - Bloomfield, CT

Full-time - Senior

Hybrid - Bloomfield, CT

Insurance Carriers and Related Activities

About the position

The Senior Manager of Medicare Advantage Provider Directory Operations and Accuracy is responsible for overseeing the accuracy of the provider directory for Medicare Advantage plans, ensuring compliance with industry standards and CMS regulations. This role involves leading cross-functional teams to track and forecast directory accuracy, managing internal audits, and collaborating with external vendors to maintain high-quality and up-to-date provider data.

Responsibilities

• Oversee the maintenance and auditing of provider data to ensure accurate information on specialties, locations, network participation, contact information, and other key attributes.
• Develop and implement processes to ensure the accuracy of provider data, including regular audits of provider directory and sourcing of high-quality data from providers and third-party vendors.
• Collaborate with internal teams (e.g., provider relations, audit team, IT) and manage external vendors (e.g., research teams, call centers, data providers) to resolve discrepancies and maintain accurate data.
• Manage the continuous improvement of internal teams and external vendors to streamline processes, reduce errors, and ultimately enhance the accuracy of directory data.
• Ensure consistent and up-to-date provider information across platforms.
• Develop and oversee the reporting framework to track and forecast key metrics related to directory accuracy.
• Generate and present regular reports to senior leadership, identifying trends, challenges, and areas for improvement.
• Use data insights to recommend changes and improvements to directory operations, ensuring directory accuracy.
• Partner with other teams (e.g., provider relations, sales, marketing) to ensure timely and accurate updates to the directory.
• Coordinate with compliance, legal, and regulatory teams to address any provider directory-related issues that may arise in audits or regulatory reviews.
• Lead, coach, and develop a team of provider directory specialists and analysts, fostering a culture of collaboration, accountability, and continuous improvement.
• Set performance goals for the team and ensure the achievement of key operational metrics related to directory accuracy, timeliness, and member satisfaction.
• Provide ongoing training and support to ensure staff are knowledgeable about industry best practices and CMS requirements.

Requirements

• Bachelor's degree in healthcare administration, business, data management, or a related field. A Master's degree is preferred.
• 5+ years of experience in provider directory operations, network management, and/or healthcare data management. Experience with Medicare Advantage is preferred.
• Experience managing offshore teams and/or external vendors.
• Experience leading cross-functional teams (with business and technical expertise) and managing large, complex projects related to healthcare data and operations.
• Strong analytical skills with expertise in data management, quality assurance, external vendor management, and/or audit processes.
• Strong leadership skills, with experience managing teams in a dynamic, fast-paced environment.
• Excellent communication and collaboration skills, with the ability to work with both technical and non-technical stakeholders.
• Proficiency in healthcare data tools and platforms (e.g., Excel, database management systems).
• Knowledge of CMS guidelines and regulatory requirements for Medicare Advantage provider directories.

Benefits

• Medical insurance
• Vision insurance
• Dental insurance
• Well-being and behavioral health programs
• 401(k) with company match
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays