• Atuar como o principal canal de comunicação com os stakeholders, coletando requisitos e alinhando expectativas de prazos e entregas; • Colaborar com o time de engenharia (Devs e QAs) para quebrar épicos em histórias técnicas digeríveis e priorizar o backlog com base em valor de negócio e esforço; • Realizar a homologação funcional das features entregues pelo time, garantindo que a regra de negócio foi implementada corretamente; • Criar e manter o Roadmap do produto, antecipando gargalos e sugerindo melhorias proativas na experiência do usuário (UX).

Job Summary: The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates complex medical conditions, determines compliance of medical documentation, identifies trends, and suggests improvements in data and processes for Continuous Quality Improvement (CQI). Key Job Functions: •Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Cigna IFP Coding Guidelines and Best Practices, HHS Protocols and any additional applicable rule set .•Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year. •Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data capture, through the lens of HHS’ Risk Adjustment. •Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners. •Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners. •Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a timely manner. •Communicate effectively across all audiences (verbal & written).•Develop and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to Cigna IFP Coding Guideline updates and policy determinations, as needed. Education & Experience: The Quality Review & Audit Analyst will have a high school diploma and at least 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC): - certified Professional Coder (CPC) - certified Coding Specialist for Providers (CCS-P) - certified Coding Specialist for Hospitals (CCS-H) - registered Health Information Technician (RHIT) - registered Health Information Administrator (RHIA) - certified Risk Adjustment Coder (CRC) certification Individuals who have a certification other than the CRC must become CRC certified within 6 months of hire. Minimum Qualifications •Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CMcoding guidelines and conventions. •Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance, with both Inpatient and Outpatient documentation •HCC coding experience preferred •Computer competency with excel, MS Word, Adobe Acrobat •Must be detail oriented, self-motivated, and have excellent organization skills •Understanding of medical claims submissions is preferred •Ability to meet timeline, productivity, and accuracy standard and High School Diploma required 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 25 - 38 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 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. 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.

• Analyze fraud alerts and account activity for unusual or suspected fraudulent activity that derive from the bank’s surveillance monitoring systems and internal/external sources; • Monitor digital content resources to proactively identify and prevent content abuse. • Research and analyze high-risk transactions across all payment channels with a sense of urgency; • Proactively identify potential risk, develop loss mitigation strategies deployed within debit card fraud systems available; • Address and investigate debit card data breaches involving financial information to minimize risk to the organization; • Conduct account investigations and research to determine if further review is warranted; • Collect and analyze large volumes of financial data for potential fraud; • Conduct due diligence, evaluate the circumstances, and recommend appropriate risk-based actions for any cases of potential fraud; escalate as necessary; • Collaborate with personnel from other departments when conducting investigations, as appropriate; • Document all findings in a centralized case management system to ensure complete documentation is maintained as required; • Communicate with FIU management on internal control deficiencies detected during the account monitoring/investigative processes; • Maintain knowledge of the bank’s products, services, customers and geographic locations, and the potential fraud risks associated with those activities; • Escalate activity that meets the established criteria for investigating suspected fraudulent or problem accounts through the submission of an Unusual Activity Referral Form; • Maintain proficiency in all aspects of BSA/AML compliance; • Adhere to all provisions of South State Bank policies and procedures, including the confidentiality policy, code of ethics and BSA/AML/OFAC policies and procedures;

• Work as part of the LCMC Health community. • Deliver extraordinary healthcare to every person and parish in Louisiana and beyond. • Collaborate with colleagues and stakeholders to enhance the healthcare experience.