• Drive Internal Control & Risk Processes: Lead the implementation of internal control and risk management across the Region. • Strategic Business Partner: Act as a trusted advisor to regional and local leadership by facilitating regular risk and control updates. • Competency Development: Partner with Regional management to build talents and internal control capabilities. • Methodology, Frameworks & Tools: Contribute to the evolution and application of Group-wide risk and control methodologies. • Cross-functional Collaboration: Coordinate with global and regional functions, internal and external audits, and other stakeholders. • Maintain an effective internal control system for the Region. • Promote Best Practices & Innovation: Foster harmonization of internal controls, promote automation, and digital solutions. • Coordinate Risk Management Processes: Partner with Global Risk Owners, Managing Directors, Risk Champions, and Subject Matter Experts. • Build Knowledge and Competencies: Deliver training and guidance to local teams on internal control and risk management practices. • Monitoring & Communication: Organize regular risk and control updates with Regions and Countries.

The job profile for this position is Fraud Lead Analyst, which is a Band 3 Senior Contributor 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. Healthcare Fraud Investigator: Make an impact protecting customers, data, and healthcare integrity. We’re looking for a skilled and motivated Healthcare Fraud Investigator to handle complex healthcare fraud matters that impact our customers and the organization. In this role, you’ll take ownership of investigations from start to finish—using sound judgment, analytic thinking, and collaboration to bring cases to resolution. This is an opportunity for investigators who enjoy digging into details, following the data, and working on high‑value cases that truly matter. What You’ll Do - Lead in‑depth investigations into suspected or confirmed healthcare fraud, using a thoughtful and independent investigative approach. - Gather, analyze, and synthesize information from a variety of sources, including claims data, records, interviews, and internal partners. - Manage complex, high‑dollar investigations with a high degree of autonomy. - Prepare clear, well‑documented investigative reports and evidence packages to support case resolution, recovery efforts, or external referrals. - Coordinate with internal stakeholders and, when appropriate, local, state, or federal agencies to support investigations. - Respond to subpoenas or regulatory inquiries and provide testimony when required, in partnership with legal and compliance teams. - Support special projects related to fraud detection, auditing, and continuous improvement of investigative practices. - Protect sensitive customer and company information, including PHI, while maintaining strict confidentiality standards. What You’ll Bring - Bachelor’s degree in Criminal Justice or 7+ years of investigative claims experience - 3+ years of healthcare fraud investigation, SIU, audit, payment integrity, or related experience. - Proven ability to manage complex investigations independently and bring them to resolution. - Strong analytical and computer skills, with proficiency in Microsoft Excel, Word, and similar tools. - Excellent written and verbal communication skills, including the ability to present findings clearly and professionally. - Comfort working with sensitive, confidential information and exercising sound judgment. - Ability to adapt to changing priorities and work effectively in a fast‑paced environment. 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 68,300 - 113,900 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 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. 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 Core Competencies: - Strategic Thinking: Anticipates operational impacts of CMS changes and EDGE updates; plans proactively to maintain compliance and performance - Project Management: Manages timelines, dependencies, and deliverables for submissions, deployments, and remediation activities. - Analytical Expertise: Leverages analytical tools to diagnose issues, validate data, and improve system accuracy - Stakeholder Management: Communicates clearly and effectively with technical teams, business partners, and external stakeholders to drive alignment - Adaptability: Adjusts quickly to evolving CMS regulations, new EDGE releases, and shifting marketplace operational needs - Collaboration: Works across cross‑functional teams to deliver high‑quality outputs and coordinated execution Qualifications / Experience: - 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. For this position, we anticipate offering an annual salary of 96,400 - 160,600 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 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.

Job Description 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. 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 Core Competencies: - Strategic Thinking: Anticipates operational impacts of CMS changes and EDGE updates; plans proactively to maintain compliance and performance - Project Management: Manages timelines, dependencies, and deliverables for submissions, deployments, and remediation activities. - Analytical Expertise: Leverages analytical tools to diagnose issues, validate data, and improve system accuracy - Stakeholder Management: Communicates clearly and effectively with technical teams, business partners, and external stakeholders to drive alignment - Adaptability: Adjusts quickly to evolving CMS regulations, new EDGE releases, and shifting marketplace operational needs - Collaboration: Works across cross‑functional teams to deliver high‑quality outputs and coordinated execution Qualifications / Experience: - 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. For this position, we anticipate offering an annual salary of 96,400 - 160,600 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 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.