The Cigna Group

Analyst

• Conduct medical records reviews with accurate diagnosis code abstraction
• Utilize HHS’ Risk Adjustment Model to confirm accuracy of HCC
• Apply longitudinal thinking to identify valid data elements
• Perform various documentation and data audits
• Collaborate and coordinate with team members and matrix partners
• Coordinate with stakeholders to execute efficient RA programs
• Communicate effectively across all audiences
• Develop and implement internal program processes ensuring compliance with CMS/HHS

Quality Review & Audit Analyst

Business Development Rep

• Drive a significant sales portfolio by building a strong network
• Partner with our go to market strategy team in understanding our value proposition
• Cultivate new business for Forsyth Health Services
• Build and execute client specific strategies and support for adoption of Forsyth Health insights & solutions
• Help clients choose the insights & solution(s) that best suit their needs
• Collaborate cross-functionally with senior leaders representing data operations, client solutions services & contract execution
• Focus on new sales and partner with go to market strategy
• Develop a pharma client/market penetration strategy and lead sales execution
• Ensure sales team goal attainment and growth through lead generation, product penetration and other sales achievements
• Watch success factors including, but not limited to, the measurement and achievement of sales targets, new business, attainment of sales revenue goals, etc.
• Serve as Executive sponsor with client decision-makers from C-Suite and executive pharma leaders

Business Development Director

Learning and Development

• Collaborate with internal clients to assess needs, coordinate, design, develop, and deliver interactive learning solutions
• Understand and have in-depth experience with the ADDIE model to create effective training solutions
• Conduct needs assessments and other types of analysis to identify gaps in employee performance or knowledge
• Demonstrate effective communication skills to serve as a learning consultant to align training strategies
• Be competent in adult learning theory and fundamental training approaches
• Use curriculum development tools to create effective e-learning training, facilitation guides, course material, and training aids
• Work within an LMS to test all courseware prior to delivery
• Maintain awareness of new developments in training and instructional design

Instructional Designer

• Lead the development and execution of Evernorth Specialty Pharma sales and business development strategy
• Own manufacturer-facing growth initiatives, including new business opportunities and therapy launches
• Partner to design and execute strategies that expand access to new and emerging therapies
• Identify, evaluate, and pursue new Pharma partnerships that drive revenue growth
• Serve as a senior thought partner in enterprise strategic planning
• Lead pharmaceutical manufacturer contracting strategy, including negotiation of complex agreements
• Oversee contract development, renewal strategy, and renegotiations
• Collaborate closely with Specialty Product, Specialty Operations, Finance, Legal, and Procurement
• Manage the budget for Business Development and Contracting functions

Managing Director – Pharma Sales, Business Development

Customer Support

• Support account managers and pharmacy partners by responding to customer inquiries and delivering timely, accurate service.
• Coordinate and document system access requests, collaborating with Legal and internal teams as needed.
• Create, update, and manage user profiles within Verity’s software, including access troubleshooting and password resets.
• Monitor data flow and system performance, proactively identifying anomalies and coordinating resolution plans.
• Execute customer setting updates within Verity’s platform as part of large‑scale initiatives or assigned projects.
• Prepare and deliver ad hoc reports to support customer meetings and presentations.
• Maintain and update internal documentation and wiki pages to reflect current processes and best practices.
• Manage and prioritize requests from multiple stakeholders, using judgment to escalate issues when appropriate.
• Adapt support approaches to meet the unique needs of different account management groups.
• Utilize a variety of tools including Jira, Confluence, Asana, Salesforce, and SharePoint to complete work efficiently.
• Leverage training resources to continuously build platform knowledge and identify development opportunities.
• Capture customer feedback to surface actionable insights that support product and service improvements.
• Model Verity Solutions’ values through positive, professional interactions with internal and external partners.

Customer Support Specialist – Pharmacy Team

Compliance

• Complete an established number of audits and monitoring per quarter for Care Delivery and Pharmacy;
• Manage the Prompt Response and Corrective Action Program;
• Lead committee meetings for various compliance elements with business stakeholders and committee members;
• Coordination and development of auditing and monitoring plans focusing on areas of Compliance risk;
• Creation of dashboards and status updates which communicate audit and monitoring results, trends, and summarize risk remediation activity;
• Deliver executive summary compliance reports and applicable findings to business stakeholders;
• Serve as subject matter expert to advise business in areas including, but not limited to care delivery, pharmacy, nursing, drug distribution, and associated regulatory requirements;
• Ensure the highest level of compliance with all Federal, State, and local rules and regulations;
• Lead, participate and facilitate accessible knowledge and guidance for business stakeholders including Compliance committees and other delivery mechanisms as needed;
• Execute training program strategy and support of business stakeholders on applicable Compliance topics;
• Research and respond to compliance questions in consultation with Legal and Compliance stakeholders;
• Collaborates with internal partners and develops good working relationships to ensure open lines of communication and timely responses to compliance questions;
• Update, revise, and maintain applicable departmental policies and procedures, and support the review of policies and documents for supported business units;
• Support business partners in issue management and resolution;
• Remain aware of industry changes and/or trends;
• Complete annual compliance program effectiveness assessments.

Senior Compliance Advisor, Care Delivery & Pharmacy

Billing Specialist

• Manage assigned book of business to ensure that goals are achieved
• Plan and organize departmental resources: people, equipment, and supplies
• Develop consistent processes and establish performance standards
• Ensure that departmental productivity, compliance, and quality standards are met
• Audit staff performance as needed
• Identify problems, define alternatives, and recommend solutions for process improvements
• Review and update policies and procedures as needed
• Openly and consistently communicate with other departments, payers, and vendors

Enrollment/Billing Supervisor

Account Manager

• Participates in the end-to-end processes for provider data accuracy vendor(s), such as LexisNexis, from initial analysis through execution and post-implementation support.
• Serves as a liaison between internal teams, external clients, and provider partners to enhance the provider experience and ensure high-quality network administration.
• Navigates organizational structures to identify and implement effective solutions.
• Escalating any identified issues to closure.
• Responsible for partnership with Compliance for new state laws ie: additional attributes, additional states, pre campaign analysis, etc.
• Analyzes reports, SLA’s and business processes to identify improvement opportunities and drive quality enhancements.
• Responsible for oversight of Directory Compliance activities, including pre and post campaign activities, reviewing burn-down plans to ensure all activities are within each state’s law.
• Maintains consistent communication with vendors, markets, and internal partners via calls, emails, and scorecards.
• Leads and supports provider data accuracy vendor(s)s.
• Contributes to strategic initiatives by identifying data collection improvements and recommending controls to ensure data accuracy.
• Evaluates business processes and technologies to identify root causes and recommend solutions.
• Defines baseline business metrics and assess the impact of outputs on customers.
• Collaborates across departments to orchestrate issue remediation and process improvements.
• Directly manage, coach, and develop a team responsible for Lexis Nexis relationship oversight, directory accuracy, and related compliance deliverables.
• Allocate resources effectively across vendor oversight, regulatory commitments, and operational priorities to meet service level expectations.
• Foster a culture of accountability, continuous improvement, and operational excellence.
• Communicates effectively and supports a culture of learning and cross-training.

Vendor Relationship Manager

General Counsel

• Independently develop, lead, and execute all facets of litigation management and strategy for their portfolio
• Manage their litigation portfolio by working collaboratively with colleagues in Legal, Compliance, Government Affairs and Communications, as well as business stakeholders
• Effectively direct, manage, and develop outside counsel
• Provide proactive, solution-oriented advice and counseling to support and protect business goals and objectives, including litigation mitigation and avoidance
• Employ highly polished and effective communication, listening, and writing skills, with a focus on interaction with and reporting to senior managers and executive leadership
• Demonstrate business acumen and understanding of the Cigna enterprise
• Participate in and contribute positively within Cigna's legal community

Associate Senior Counsel – Healthcare, Commercial Litigation

Manager

• Partner with customers to assess needs, develop individualized care plans, and document interventions and outcomes in Cigna medical management systems.
• Collaborate with customers and providers to establish goals, interventions, and evidence-based plans of care.
• Apply motivational interviewing, behavior change strategies, and shared decision-making to drive engagement and improved health outcomes.
• Empower customers to effectively navigate the healthcare system and communicate with providers.
• Coordinate care across customers, caregivers, providers, and internal partners via phone and digital channels (email, text, chat).
• Collaborate with interdisciplinary teams—including pharmacists, nutritionists, behavioral clinicians, Medical Directors, and Medical Management programs—to support whole-person health.
• Track, analyze, and document daily activity, volume, and outcomes to support performance and quality goals.
• Follow established policies, procedures, and Case Management performance measures.
• Efficiently navigate multiple systems and applications in a fast-paced, customer-focused environment.
• Complete required training and maintain clinical knowledge, licensure, and certifications.

RN – Complex Nurse Case Manager

Software Engineer

• Serve as a key member of the Provider Guarantees Management team, supporting pharmacy contractual guarantee tracking and analysis.
• Own and maintain the SQL code that populates the team’s pharmacy tracking database.
• Manage all aspects of pharmacy contractual guarantee SQL code, including development, enhancement, validation, and ongoing support.
• Interpret business requirements and translate them into clear technical specifications and SQL implementations.
• Exercise considerable creativity, foresight, and judgment in conceiving, planning, and delivering technical initiatives.
• Ensure data accuracy, integrity, and reliability for pharmacy guarantee tracking and reporting.
• Partner with business stakeholders to understand requirements, resolve issues, and deliver scalable technical solutions.
• Provide ad hoc technical support for the PGM team.

Senior SQL Developer, Provider Guarantee Management

• Partner with customers to assess needs, develop individualized care plans, and document interventions and outcomes in Cigna medical management systems
• Collaborate with customers and providers to establish goals, interventions, and evidence-based plans of care
• Apply motivational interviewing, behavior change strategies, and shared decision-making to drive engagement and improved health outcomes
• Empower customers to effectively navigate the healthcare system and communicate with providers
• Coordinate care across customers, caregivers, providers, and internal partners via phone and digital channels (email, text, chat)
• Collaborate with interdisciplinary teams—including pharmacists, nutritionists, behavioral clinicians, Medical Directors, and Medical Management programs—to support whole-person health
• Track, analyze, and document daily activity, volume, and outcomes to support performance and quality goals
• Follow established policies, procedures, and Case Management performance measures
• Efficiently navigate multiple systems and applications in a fast-paced, customer-focused environment
• Complete required training and maintain clinical knowledge, licensure, and certifications

Oncology Nurse Case Manager

Human Resources

• Ensure accurate configuration, eligibility rules, and balances for PTO, leaves of absence, disability, and other time away programs.
• Resolve complex and escalated absence and leave issues, applying strong analytical and troubleshooting skills to deliver timely, high-quality outcomes.
• Maintain and enhance Workday time and absence configurations, integrations, and calculations, with attention to downstream impacts.
• Partner with external vendors and internal teams to resolve defects, support implementations, and execute user acceptance testing.
• Identify trends, risks, and recurring issues, recommending improvements that strengthen compliance, system reliability, and the employee experience.
• Support annual processes such as accrual adjustments, balance audits, and program rollovers.
• Interpret federal, state, and local leave regulations and translate requirements into system and process updates.
• Collaborate with Employee Relations, Legal, Payroll, Compensation, and Benefits partners on complex cases and policy interpretation.
• Develop clear job aids, documentation, and testing materials that enable consistent and accurate execution across teams.

Senior Human Resources Operations Analyst – Absence & Leave

• Partner with customers to assess needs, develop individualized care plans, and document interventions and outcomes in Cigna medical management systems
• Collaborate with customers and providers to establish goals, interventions, and evidence‑based plans of care
• Apply motivational interviewing, behavior change strategies, and shared decision‑making to drive engagement and improved health outcomes
• Empower customers to effectively navigate the healthcare system and communicate with providers
• Coordinate care across customers, caregivers, providers, and internal partners via phone and digital channels (email, text, chat)
• Collaborate with interdisciplinary teams—including pharmacists, nutritionists, behavioral clinicians, Medical Directors, and Medical Management programs—to support whole‑person health
• Track, analyze, and document daily activity, volume, and outcomes to support performance and quality goals
• Follow established policies, procedures, and Case Management performance measures
• Efficiently navigate multiple systems and applications in a fast‑paced, customer‑focused environment
• Complete required training and maintain clinical knowledge, licensure, and certifications