• Liderar y coordinar equipos técnicos asegurando el cumplimiento de hitos y la calidad del entregable. • Gestionar la relación directa con el cliente para el levantamiento y refinamiento de necesidades técnicas. • Diseñar arquitecturas de software robustas basadas en principios de escalabilidad y mantenibilidad. • Desarrollar soluciones de código complejas y realizar Pruebas de Concepto (PoC) para validar nuevas tecnologías. • Asegurar la aplicación de buenas prácticas de programación y estándares de seguridad en todo el ciclo de vida. • Mentorizar a los desarrolladores del equipo fomentando el crecimiento profesional y la cohesión técnica. • Supervisar el despliegue y la operación de servicios en entornos de Google Cloud Platform.

• Build and evolve a unified marketing technology platform • Take full ownership of 5+ existing services • Develop and maintain production-grade integrations with Meta / TikTok / Google • Redesign the tracking architecture • Eliminate manual operational workflows • Proactively identify and implement new martech solutions

The job profile for this position is Health Services Manager, which is a Band 4 Management Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Role Summary The Clinical Waste & Abuse (CWA) Complex Claim Program leader oversees pre- and post-pay medical record reviews to support accurate coding, billing, medical necessity determinations, and coverage decisions in alignment with the benefit plan and Cigna Medical and Reimbursement Policies. This leader manages and develops a team of Registered Nurses and drives a quality, cost-effective approach to high-cost claim review operations. Key Responsibilities - Hire, onboard, and retain staff; foster engagement and accountability. - Monitor daily inventory, capacity, and financial performance to ensure alignment with goals. - Serve as the subject matter expert for clinical pre-pay requests and key matrix partner needs. - Coach the team on workflows, processes, and tools; reinforce best practices and quality standards. - Track service metrics and quality results; review work regularly and take action to address trends and gaps. - Set clear objectives and performance expectations for direct reports aligned to operational priorities. - Provide ongoing performance coaching, career development support, and feedback; support talent planning and succession. - Communicate effectively with stakeholders across the Complex Claim Unit, including Medical Directors and matrix partners. Required Qualifications - Active, unrestricted Registered Nurse (RN) license in state of residency. - Three years of experience in Complex Claim Review (CCR) or Clinical Waste & Abuse (CWA) review. - Experience with CCR/CWA operations, including high-dollar bill review. - Three years of working knowledge of the insurance industry and end-to-end claims processes. Preferred Qualifications - Prior people leadership experience. - Strong problem-solving skills with the ability to apply systems thinking to business solutions and manage change. - Medical coding experience. - Ability to manage multiple priorities, meet objectives, and maintain attention to detail. - Proficient critical thinking and decision-making skills. - Ability to think strategically, design action plans, and execute. - Attention to detail - Detailed understanding of cover policies and reimbursement policies. - Demonstrated strong leadership skills. - Demonstrated excellence in the application of decision-making skills. - Demonstrated ability to initiate, research, prioritize, plan, coordinate and organize - Excellent written and verbal communication and strong interpersonal skills. - Proficiency in Microsoft Office (Excel, PowerPoint) and other common business tools. - Knowledge of applicable state and federal statutes and regulations related to claim processing. - Experience in training and staff development. - Experience managing remote staff. 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 93,000 - 155,000 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. For more details on our employee benefits programs, click here. 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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Job Description Evernorth CareNav+ Call & Chat Service Model Role Title: Evernorth CareNav+ Care Guide - PBS Career Band: High Band 2 - Analyst The hours of operation for this role are 8am-11pm EST, Monday-Friday. This position supports a resolute team for our clients Evernorth app & Express Scripts Pharmacy inquiries with expanded responsibilities in proactively educating on and recommending a multitude of Evernorth programs and services. The team consists of highly analytical, technical-minded Customer Service experts with depth of knowledge in resolving and navigating within a multifaceted health care setting. Candidates must have a proven track record in solutioning complex claim issues, identifying & navigating critical health conditions, and diligence in every interaction ensuring an accurate and firm focus on timely resolution. Ideal candidates must possess the ability to listen intently with a focus first on resolution to the reason for their outreach followed by recommendation of pharmacy benefit and vendor offerings that will achieve optimal emotional, financial, and physical health outcomes. This position must think and perform more critically & creatively, leveraging their call-center experience with a keen problem-solving skill to take their service in this role to the next level. The ability to operate in the absence of precise work instruction is critical for success.   This position will have the following responsibilities related to supporting the pharmacy & Evernorth app needs of our members: - Will provide the highest level of service on inbound member interactions with some candidates also providing digital chat support to customers. - Assists customer with the Evernorth app including but not limited to: 1) Helping download, register, and log into the app; 2) Inform of all app features and highlight navigation steps to find vendor offerings; 3) Educate on Wellness Rewards and value propositions; 4) Troubleshoot app & provide follow-up on tickets submitted for resolution. - Supports member inquiries and needs for their Express Scripts mail order account including but not limited to: 1) Eligibility; 2) Benefit quotes; 3) Complex claim resolution or education; 4) Cost savings strategies; 5) Advanced support with prior authorizations; Advanced support on claims rejections & overrides. - Required to have a strong and thorough understanding of the full suite of Medical & Pharmacy benefits and external vendor offerings. - Confidently partner with other departments to ensure all members’ needs met to achieve resolution and recommendations for next steps in their healthcare journey. - Listens to understand members unique needs, while seeking more information through probing questions with the goal of offering vendor programs and services that apply to their past, current or future needs. - Investigates and resolves escalations, barriers to care, and complaints obtaining necessary information from policies and procedures. When knowledge base documents are not available to guide next steps, must be able to determine the best solution or option autonomously and accurately for customer. - Proactively offer outreaches to pharmacy, doctor or vendors as needed to bring next steps into action or resolution removing effort from the member. - Takes ownership and provides timely follow-up on any takeaway from member interactions. i.e., Evernorth app tickets, prior authorizations pending, findings from claim discrepancies, etc. - May serve as primary contact and liaison between customers, health plans, service centers, and/or functional areas. - Thorough technical knowledge of products and excellent communication skills. - Be a champion of change and adapt well to frequent adjustments to procedures. - Must be highly coachable and open to feedback to improve member experience driving a consistently accurate quality of service. QUALIFICATIONS: - High School, GED or higher required and/or 2+ years’ work experience in customer service field. - Required 1+ years call experience in US Commercial Pharmacy Call Operations background; specifically PBM Commercial trained. - Ability to actively listen to understand current needs and complexities while identifying the next steps & potential future needs - Excellent written and verbal interpersonal communication skills - Adept with KnowledgeXchange & initiative-taking resource utilization - Confidence with technology, innovational progress, and ability to toggle three or more systems - Creative problem-solving and analytical skills with self-awareness of time to resolution - Proven record of working independently to manage day in a fast-paced, quality driven environment - Proficiency in Outlook and WebEx PERFORMANCE REQUIREMENTS: - Consistently strong KPI scores over the last 12 months must be meeting or exceeding current targets. - Quality: ≥95% - Resolution: ≥90% - CSAT: ≥4.75 - Caller Effort: ≥85% 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. 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 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.