ACA Risk Adjustment EDGE Administrator - Cigna Healthcare - Remote

The Cigna Group

15d • Remote

About The Position

The ACA Risk Adjustment EDGE Administrator plays a critical role in ensuring compliant, efficient, and high‑quality operation of Cigna’s EDGE server environment supporting ACA Risk Adjustment. This position is ideal for a proactive, detail‑oriented professional with strong technical acumen and a passion for healthcare data. The EDGE Administrator will oversee daily operations, manage data submissions, monitor processing outcomes, and collaborate across business and technical teams to maintain compliance with CMS regulations in a fast-paced, evolving environment.

Requirements

• Bachelor’s degree in Information Systems, Computer Science, Data Analytics, Public Health, or related field (or equivalent experience)
• 3+ years of experience in ACA Risk Adjustment and EDGE operations
• Deep understanding of ACA Marketplace operations, Risk Adjustment methodology, and CMS EDGE submission requirements
• Familiarity with CMS communication channels (e.g., REGTAP, FM Community) and published guidance (e.g., O&MM manuals, ICD, EDGE Server Business Rules)
• Hands‑on experience with AWS services relevant to EDGE workflows (e.g., Infrastructure as Code, Terraform)
• Proficient in using Databricks to create unity catalogs, pipelines,
• Proficiency in SQL and SAS to query, analyze, and manage large healthcare datasets (i.e., preparing ETL and ELT scripts)
• Proficiency in Tableau to present insights through reports and dashboards
• Fluent in data warehousing, data modeling, and business intelligence concepts and tools
• Demonstrated track record of troubleshooting large healthcare data files and EDGE validation errors
• Excellent problem‑solving skills with the ability to perform root cause analysis and recommend sustainable solutions
• Familiarity with healthcare regulations (e.g., HIPAA)
• 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.

Responsibilities

• Manage day‑to‑day operations of the CMS EDGE server, including file ingestion, error resolution, and submission monitoring
• Coordinate execution of baseline, incremental, and command‑driven processes for Cigna’s AWS‑hosted EDGE environment
• Monitor release updates, reference data changes, and deployment timelines to keep the system in sync with CMS schedules
• Oversee troubleshooting and remediation of file processing, configuration, and validation errors within the EDGE environment
• Interpret CMS technical guidance, ICD updates, O&MM manual changes, and regulatory communications to ensure aligned EDGE operations
• Conduct quality checks, reconcile enrollment and claims data, and support risk score accuracy and regulatory compliance
• Collaborate with IT security and infrastructure teams to monitor and maintain EDGE instances in accordance with CMS requirements and Cigna policies
• Maintain documentation of procedures, system configurations, data flows, and operational controls
• Collaborate with teams to maintain and optimize data pipelines using AWS, Databricks, Python, SAS, and Oracle to support EDGE submissions and related analytics

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level