Express Scripts

Claims Representative - Remote Location: Remote - USA Category: Customer Service & Claims Job Id: 26007462 Job Description: SUMMARY The claims representative is responsible for manually reviewing and processing medical, supplemental, or dental claims. Claims are processed according to benefits, eligibility, and internal processes, policies, and procedures and may be completed, held for additional information/review, or denied. New claim representatives will be provided with a robust training program, which includes virtual classroom training, on-the-job learning/feedback, and gradually increasing claims per hour/quality requirements over several months. After completion of training, claim representatives must meet specific accuracy/quality, volume/claims per hour, and on production performance metrics. $19/Hour Pay Rate RESPONSIBILITIES · Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines. · Confirm the presence of necessary documents within submitted claims. · Validate the accuracy of medical codes provided in claim submissions. · Assess the eligibility status of claims based on established criteria. · Review and verify other insurance coverage information in submitted claim. · Evaluate authorizations provided in claim submissions for accuracy. · Analyze account benefit plans to ensure claims align with coverage and policies. · Identify discrepancies, errors, or missing information. · Utilize multiple computer applications simultaneously. · Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision. · Meet or exceed quality and productivity goals. · Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows. · Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors. QUALIFICATIONS · High school diploma or equivalent · Ability to quickly learn a variety of computer applications to complete job functions, · Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook. · Knowledge of basic Microsoft Excel functions, such as filtering/sorting. · Experience in navigating multiple computer applications through the use of shortcut keys and other techniques. · Detail-oriented with experience in applying complex policy/procedure documents. · Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines. · Proven experience completing work with quality and productivity performance standards. · Experience working independently in a virtual environment preferred. · Experience with medical and insurance terminology in a professional setting preferred. · Knowledge of CPT/ICD-10 codes preferred. · Proven experience in health insurance claims processing or similar field preferred 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. For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. 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, paid holidays, and leaves of absence. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

Title: Patient Care Coordinator- Evernorth- Oakdale, PA Location: Oakdale United States Job Description: time type Full time job requisition id 26006094 Patient Care Coordinator (Customer Service Associate Analyst) -Evernorth- Oakdale, PA Make an Impact Where Care Meets Coordination Join CarePathRx as a Patient Care Coordinator (Customer Service Associate Analyst) and play a meaningful role in helping patients access life-changing specialty medications. In this role, you will partner closely with pharmacists, patients, caregivers, and providers to ensure every interaction supports safe, timely, and compassionate care. We are looking for someone who is energized by helping others, communicates with empathy and clarity, and is motivated to grow their healthcare knowledge while delivering an exceptional patient experience. Hours/Schedule: Monday-Friday, Rotating schedule, 8am-5:30pm Training onsite in our Oakdale, PA office (12 weeks), then remote Responsibilities • Coordinate timely medication deliveries by managing inbound and outbound phone calls with patients, caregivers, and healthcare teams • Build trust with patients through clear, compassionate communication that supports understanding of therapy, next steps, and expectations • Use active listening and thoughtful questioning to identify patient needs, remove barriers, and improve adherence to therapy • Translate complex or clinical information into simple, easy-to-understand language for patients and caregivers • Support accurate and efficient prescription processing by setting up and updating medication orders in collaboration with pharmacists • Strengthen patient care through proactive follow-up that reinforces education, resolves concerns, and ensures continuity of therapy • Maintain accurate, complete patient records and document all interactions clearly to support safe, coordinated care • Deliver a consistent, high-quality service experience that reflects professionalism, empathy, and responsiveness across every interaction • Act as a key connector between pharmacy operations, clinical teams, and external providers to streamline coordination • Contribute to a high-performing team by meeting or exceeding productivity and quality benchmarks • Continuously look for opportunities to improve communication approaches and enhance the patient experience Qualifications Required Qualifications • High school diploma or GED • Minimum 1+ years of experience in customer service, healthcare support, or a related field • Strong verbal and written communication skills with the ability to engage patients with empathy and clarity • Demonstrated ability to explain information in a patient-friendly way • Active listening skills and ability to navigate sensitive conversations • Ability to manage multiple priorities in a fast-paced environment • Basic proficiency with Microsoft Office tools • Strong attention to detail and commitment to accurate documentation Preferred Qualifications • Pharmacy Technician Certification (CPhT) • Experience in specialty pharmacy or healthcare coordination • Familiarity with medication ordering and patient assessments • Experience with EMR or pharmacy systems • Experience supporting patients with complex or chronic conditions As part of Evernorth Health Services, this role supports CarepathRx within our Pharmacy and Care Delivery organization. Our teams are ambitious, compassionate experts dedicated to advancing specialty pharmacy and infusion services in partnership with hospitals and health systems—always with patients at the center of what we do. 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. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Title: Technical Training Lead Representative - Cigna Healthcare - Remote Locations: - Montana, United States of America - Arizona, United States of America - Colorado Springs, Colorado, United States of America - Idaho, United States of America - North Carolina, United States of America - North Dakota, United States of America - Oregon, United States of America - South Carolina, United States of America - South Dakota, United States of America - Texas, United States of America - Utah, United States of America - Virginia, United States of America - Wyoming, United States of America Work Type: Remote Job ID: Id26006332 Job Description: Role Summary Are you passionate about developing talent and building strong foundational skills? As a Claims Examiner Trainer (Technical Training Lead Representative), you will play a critical role in onboarding and developing Claims Examiners through structured training, facilitation, and knowledge transfer. You will assist in designing and delivering engaging learning experiences that promote accuracy, efficiency, confidence, and independence in claims processing. In this role, you will help foster a positive, team-focused environment while ensuring all training aligns with Allegiance standards, processes, and quality expectations. Key Responsibilities - Develop and lead training for new claims examiners either in one and one or group training as directed (including training on all milestone items) - Maintain and update training milestones as needed - Complete series of Allegiance Core Trainings (ACTs) as employees are hired - Review, enhance and update ACTs and track changes - Assist in refresher training for current claims examiners either in one on one or group training as directed - Learn different groups across our book of business - Communicate trainee progress to Onboarding Coordinator - Schedule and lead bi-weekly training update meetings with Onboarding Team Leader for each trainee. - Promptly report any trainee issues including personnel, training progress, etc. to the Onboarding Team Leader and Claims Examiner Training Team Leader. - Intermittent travel - Contribute to the daily workflow with regular and punctual attendance. - While training new claims examiners, fulfill all claims examiner functions as listed below: - Ensures accurate and complete claims processing by verifying required documentation, collaborating with relevant parties to obtain necessary information, and confirming system adjudication aligns with plan provisions. - Prepares and distributes written correspondence to plan participants and providers regarding pre-determinations and responses to basic benefit inquiries. - Is a support and resource to the department when necessary Required Qualifications - High School Diploma or GED (Bachelor’s degree preferred) - Strong computer skills with proficiency in Microsoft Word, Outlook, and Teams Preferred Qualifications - Strongly preferred 1+ year of claims examining experience with Allegiance’s processes, systems, and resources, including LuminX - 1+ year of coaching, mentoring, or training experience - 1+ year of experience with medical terminology and basic health insurance concepts - Working knowledge of Excel and PowerPoint - Ability to read and interpret benefit plans, insurance documents, and regulatory requirements - Proven ability to work in a fast‑paced environment, manage multiple tasks, and solve problems effectively Core Skills & Competencies - Strong verbal and written communication skills - Skilled listener with excellent interpersonal and teamwork abilities - Customer‑focused mindset with attention to detail and accuracy - Ability to motivate, influence, and support others in achieving performance goals About Allegiance by Cigna Healthcare Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation’s most innovative health benefit strategies. 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. For this position, we anticipate offering an hourly rate of 22 - 33 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. 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 About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

Title: Medical Director - Pediatric Endocrinology - Evicore - Remote Location: Remote, US Category mMedical & Pharmacy Job Id26006236 Job Description: Do you crave an intellectually stimulating role that lets you apply your clinical expertise while continuing to grow and make an impact? As a Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll leverage your background in Pediatric Endocrinology to deliver evidence-based medical reviews that support high-quality patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: - You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. - Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. - Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. - Leverage your clinical expertise to recommend alternative services or treatments as necessary. - Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: - Benefits start on day one - Predictable work schedules - 100% work from home - 8 Paid Holidays + 23 PTO Days - 401(K) with company match - Reimbursement for continuing medical education - Career growth opportunities across the enterprise - Networking with peers across multiple medical specialties Requirements: - M.D. or D.O. with a current, active U.S. medical license and board certification (ABMS or AOA) in Pediatric Endocrinology - Eligible to acquire additional state licensure as required - 3 years of relevant clinical experience post residency/fellowship - Knowledge of applicable state and federal laws, Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus - Ability to commit to a set, weekly work schedule (Monday through Friday) - Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems - Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time - In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. 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. For this position, we anticipate offering an annual salary of 207,800 - 346,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. 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. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Title: Encore Staff Pharmacist - Remote Location: Remote, US Admin/Corporate Services Job Description: POSITION SUMMARY The Staff Pharmacist interprets physicians’ prescriptions, contacts doctors or other prescribers and/or patients to verify information on prescriptions and expedite processing of order. This position is responsible for dispensing medications within corporate and regulatory guidelines. The Staff Pharmacist will track order status and outstanding issues as well as consult with patients regarding the use of medications and potential drug interactions. This individual may take calls from clients regarding orders or clarification, maintain daily production, quality and service levels, vary work priorities and activities to accommodate business needs. ESSENTIAL DUTIES - Interpret physicians’ or prescribers’ prescriptions. Contact doctors and/or patients to verify information on prescriptions such as drug strength, prescription sig., and drug name in order to expedite processing of orders. Verify and confirm validity of controlled substances. - Verify prescription information entered in the system by data entry or order entry. Contact physicians for new and/or transfer authorization. Work with physicians to convert prescriptions to generic or preferred drugs whenever possible. - Consult with patients regarding the use of medications and potential drug interactions. ESSENTIAL FUNCTIONS: - Accurately and efficiently processing prescription orders received through mail or electronic channels. - Conducting thorough reviews of incoming prescriptions for accuracy, completeness, and potential drug interactions. - Providing medication counseling and addressing patient inquiries regarding drug usage, side effects, and precautions. - Collaborating with healthcare providers to resolve any prescription-related issues. - Adhering to all applicable legal and regulatory requirements, including pharmacy laws and privacy guidelines. - Participating in quality assurance programs and continuous improvement initiatives. - Staying updated on new medications, pharmaceutical regulations, and industry developments. - Additional duties as assigned by leadership. Required: - Registered pharmacist, in good standing in the state - A degree in pharmacy (PharmD or BS) - Experience working in a pharmacy setting, preferably with mail order or similar experience - Knowledge of pharmacy laws and regulations - Strong focus on customer service, quality and accuracy - Ability to read and interpret prescriptions - Detail-oriented with strong organizational skills - Excellent oral and written communication skills - Ability to adapt in a dynamic work environment - Ability to learn quickly, solve problems and make decisions in a timely fashion - Able to work under pressure and to meet tight deadlines - Be compliant with the work from home policy which includes but is not limited to conducting business in a private area where others are not present located to ensure that company and patient information is kept confidential - Knowledge of Microsoft Office software (Outlook, Word, Excel and PowerPoint) - Knowledge of Pharmacy Benefits Management Industry/Managed care industry is an asset - Must be able to work scheduled shifts - Ability to successfully complete Express Scripts’ required training program - 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. 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. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

Title: Medical Director - Gastroenterology - Evicore - Remote Location: Remote, US Job Description: Do you crave an intellectually stimulating role that lets you apply your clinical expertise while continuing to grow and make an impact? As a Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll leverage your background in Gastroenterology to deliver evidence-based medical reviews that support high-quality patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: - You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. - Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. - Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. - Leverage your clinical expertise to recommend alternative services or treatments as necessary. - Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. What you’ll enjoy about working here: - Benefits start on day one - Predictable work schedules - 100% work from home - 8 Paid Holidays + 23 PTO Days - 401(K) with company match - Reimbursement for continuing medical education - Career growth opportunities across the enterprise - Networking with peers across multiple medical specialties Requirements: - M.D. or D.O. with a current, active U.S. medical license and board certification (ABMS or AOA) in Gastroenterology. - Eligible to acquire additional state licensure as required - 3 years of relevant clinical experience post residency/fellowship - Knowledge of applicable state and federal laws, Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus - Ability to commit to a set, weekly work schedule (Monday through Friday) - Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems - Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time - In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. 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. For this position, we anticipate offering an annual salary of 207,800 - 346,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. 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. For more details on our employee benefits programs, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Coordinate medication needs and pharmacy insurance coverage for patients with complex conditions. Perform benefit verification and insurance review. Collaborate with departments to resolve issues and handle patient complaints with discretion.

Title: Autism Clinical Support Behavioral Licensed Clinician - Evernorth - Remote Location: CT-Bloomfield Job Description: Our mission is to provide immediate, personalized clinical support—whether it’s a moment of crisis, clinical consultation, or a step towards lasting change. Our mission is to be responsive, collaborative, and impactful with each connection. As a Behavioral Licensed Clinician on our 24/7 Clinical Support Team, you will deliver expert, compassionate care across a wide spectrum of behavioral health needs, and especially members with autism and their families. This team is designed to ensure continuity—each Behavioral Licensed Clinician remains with the member throughout their journey, becoming a trusted clinical partner. While every team member supports various clinical populations and needs, we value and will leverage subject matter expertise in the development of training, curriculum, and clinical consultation. You’ll be called on to bring depth into your areas of specialization while remaining flexible and responsive across all cases. The successful candidate will have demonstrated clinical excellence with mental health, most particularly regarding autism, as well as substance use disorders, crisis call work, and case management with a passion to deliver a service experience that exceeds the member’s or provider’s expectation. The team works in a fast-paced environment, on a queue, taking telephonic calls in the moment, balanced with scheduled calendar appointments. The team operates 24/7/365 in support of the full organization. Duties and Responsibilities - Serve as a consistent clinical point of contact for each member through every stage of their wellness journey - Assess members’ immediate risk and clinical needs using evidence-based models and clinical acumen - Provide real-time crisis de-escalation, safety planning, and risk management - Identify biopsychosocial needs and collaborate with the member to determine solutions and next steps - Develop SMART goals that empower members to lead and maintain a healthy lifestyle - Assesses readiness to change and implements actions to assist members in moving through stages of change to reach their goals - Shepherd members to appropriate clinical care, treatment programs, and community resources - Incorporate a variety of modalities to educate members about benefit plans, coverage, and care navigation - Leverage an evidence-based specialized curriculum in a wide range of clinical areas that support our members’ unique needs - Perform research and provide relevant educational or support resources tailored to the member’s situation - Partner with internal colleagues to ensure timely follow-up, case collaboration, and seamless care transitions - Demonstrate agility in balancing real-time queue work with out-of-queue case management responsibilities - Exhibit diplomacy, empathy, and professionalism—even in difficult conversations or with resistant participants - Comply with HIPAA and uphold strict confidentiality and compliance standards while demonstrating sound clinical documentation practices - Able to manage multiple health records and systems to accurately document customer interactions and progress - Communicate effectively and succinctly in both verbal and written format - Perform other related duties incidental to the work described herein Qualifications - Master’s degree or PhD in a mental health field (e.g., Social Work, Counseling, Psychology). - Current independent clinical license (e.g., LCSW, LPC, LMFT, LPCC, PhD, PsyD, or PMHNP) - Minimum 5 years of post-licensure experience as a behavioral health clinician - Specialized training or experience working with Autism Spectrum Disorder is preferred - Demonstrated use of evidence-based approaches, including brief therapy, cognitive-behavioral therapy, and motivational interviewing - Experience working in or with managed care environments preferred - Experience with direct member communication (written and verbal), experience in telephonic counseling/coaching preferred - Required to obtain AAS Crisis Specialist Certification within the first year of employment - EAP (Employee Assistance Program) experience and CEAP certification preferred but not required - Strong clinical acumen, interpersonal communication skills, and comfort working in a dynamic and rapid pace environment - Proven administrative abilities, with strong computer and software application skills REQUIRED WORK HOURS: Full-time job with a minimum of forty hours per week. Shift days and times may vary due to business need. All staff schedules could include rotating shifts, weekends, and holiday time. 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. For this position, we anticipate offering an annual salary of 67,100 - 111,800 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. 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. For more details on our employee benefits programs, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Title: Senior Advisor, Data Science - Medical Cost Trend & Forecasting - Hybrid/Remote Location: USA remote Job Description: Technology Job Id26006423 Join our Data Science Center of Expertise and help shape the future of healthcare forecasting. In this role, you will drive innovative approaches to medical cost trend forecasting and reserving, improving accuracy and enabling smarter financial decisions. You will work with cross-functional partners to bring advanced analytics to life and strengthen the predictability and stability of our business. Responsibilities - Lead the design and delivery of advanced medical cost forecasting solutions that improve claim reserving and enterprise financial forecasting - Prototype and validate new analytical approaches using techniques such as time series modeling, simulation, and machine learning - Create diagnostics and performance measures to evaluate forecast accuracy and explain key cost drivers - Partner with finance, actuarial, and business teams to translate forecasting needs into actionable analytics solutions - Communicate findings through clear insights, presentations, and technical documentation to support decision-making - Develop early-warning analytics to identify emerging cost trends and risks - Collaborate with data engineering and product teams to ensure scalable and interpretable solutions - Contribute to model monitoring, governance, and continuous improvement processes - Mentor junior team members and share best practices across the data science community Qualifications Required Qualifications - 5+ years of experience in data science, analytics, or a related field - Strong proficiency in Python, SQL, machine learning, and statistical modeling - Hands-on experience with forecasting techniques such as time series analysis, simulation, or scenario modeling - Experience working with large datasets using platforms such as Databricks or Spark - Ability to communicate complex analytical concepts to technical and business audiences - Experience partnering cross-functionally to deliver data-driven solutions Preferred Qualifications - Experience in healthcare payer analytics, including medical cost trend, reserving, or pricing - Experience with anomaly detection or advanced statistical techniques - Knowledge of model lifecycle management and best practices for reproducible research - Demonstrated ability to mentor and guide junior team members 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. For this position, we anticipate offering an annual salary of 131,200 - 218,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. 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. For more details on our employee benefits programs, click here. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Title: Product Management Senior Manager - Express Scripts - Hybrid Locations: - Morris Plains, New Jersey, United States of America - St. Louis, Missouri, United States of America Work Type: Hybrid Job ID: Id26006028 Job Description: Bring your passion for innovation and client impact to a role where communication truly matters. As a Product Management Senior Manager you will lead a high-performing team and shape how we deliver meaningful, compliant, and high-quality communications to over 100 Medicare clients. This is an opportunity to combine strategy, leadership, and execution to create better member experiences. We are looking for someone who is energized by collaboration, inspired by continuous improvement, and motivated to make a measurable difference. Responsibilities - Lead and inspire a team of Member Experience Managers, setting clear priorities, balancing workloads, and supporting ongoing development and recognition - Own the end-to-end communication strategy and execution for EGWP clients, ensuring quality, timeliness, and compliance across all deliverables - Drive communications from concept through production, partnering across teams and systems to deliver seamless outcomes - Strengthen client relationships by leading meetings, sharing updates, and proactively addressing communication needs - Monitor performance metrics such as turnaround time and quality, using insights to continuously improve processes and outcomes - Translate CMS marketing guidance into actionable updates for client communications, ensuring accuracy and compliance - Build and execute communication timelines, especially in preparation for Annual Enrollment Period, to support scalable delivery - Contribute to broader product and marketing strategies, including identifying opportunities for enhancement, efficiency, and innovation - Serve as a subject matter expert in communications processing systems (e.g., Blue-Ray, Wrike), helping teams work smarter and more efficiently - Identify and implement process improvements, including the use of AI and automation, to enhance speed, accuracy, and scalability - Represent EGWP communications in key forums, presenting insights and influencing decisions across leadership and stakeholders Qualifications Required - Minimum of 6+ years of experience in product management, communications, or a related field - Minimum of 2+ years of experience leading people or managing teams - Experience working in a highly regulated environment (e.g., healthcare, Medicare, or insurance) - Proven ability to lead cross-functional initiatives and deliver complex work from concept through execution - Strong communication and presentation skills, with experience engaging clients and senior stakeholders - Demonstrated ability to manage multiple priorities while maintaining high quality and attention to detail Preferred - Experience supporting EGWP or Medicare communications - Familiarity with CMS marketing guidelines and regulatory requirements - Experience with communications or workflow systems such as Blue-Ray or Wrike - Experience leveraging AI or automation to improve processes - Bachelor’s degree or equivalent experience 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. For this position, we anticipate offering an annual salary of 131,400 - 219,000 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. 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.