Quality Validation Sr. Advisor - Hybrid - Cigna Healthcare

Cigna • Saint Louis, MO

288d • Hybrid

About The Position

This is a hybrid position (3 days per week in-office + 2 days work at home). The incumbent candidate can be based out of any US Cigna Healthcare office. This position is a Hybrid role which requires office alignment but is not restricted to locations that are identified in this posting. The Quality Validation Senior Advisor will align to the of Cigna Pharmacy Business UM Operations Team and will be responsible for validating business requirements within the Medication Utilization Management applications against gathered business requirements. This role requires a keen understanding of downstream impacts and meticulous attention to detail.

Requirements

• Bachelor's degree required, Master's degree preferred.
• Minimum of 5 years of experience in healthcare utilization management or a related field.
• Ability to work independently and adapt quickly to changing environments.
• Comfort with complex systems and processes.
• Excellent strategic thinking and problem-solving abilities.
• Process optimization and efficiency improvement.
• Strong analytical and decision-making skills.
• Experience with OnePA, CSP, ATK, and medical/drug claim processing is strong plus.
• Proficiency in Microsoft Office, including Excel and Access.
• Strong organizational skills and ability to manage multiple projects.
• Ability to travel as needed up to 10%.

Responsibilities

• Develop a process to validate that cross-functional business and formulary strategy requirements are accurately implemented and functioning as expected and through testing in various enterprise applications: OnePA, CSP, ATK, pharmacy and medical claims.
• Analyze and document the behaviors of applications, with a focus on downstream impacts including communications.
• Possess a working knowledge of prior authorization processes and claims adjudication and ensure end to end process is not broken.
• Collaborate with cross-functional partners to resolve complex issues.
• Document findings in a clear and relevant manner to be reviewed at leadership level.
• Other tasks as assigned.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree