The job profile for this position is Program Management Senior 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. This role plays a critical part in supporting non-participating cost containment efforts by ensuring accurate, timely, and thoughtful manual pricing decisions. You will collaborate with experienced professionals to evaluate complex claims and contribute to solutions that drive consistency, quality, and positive customer outcomes across the organization. Responsibilities - Perform manual pricing for Maximum Reimbursable Charge (MRC1/MRC2) claims, ensuring accuracy, compliance, and alignment with pricing guidelines. - Analyze complex, sensitive, or escalated claims and recommend pricing outcomes that balance cost containment with customer experience. - Evaluate system and process challenges, identifying practical solutions that improve efficiency, accuracy, and overall results. - Provide clear analysis, pricing rationale, and guidance to internal and external partners requesting manual pricing support. - Take informed, decisive action on priority issues while managing multiple requests in a fast-paced environment. - Contribute to continuous improvement by sharing knowledge, strengthening functional expertise, and supporting team learning. - Support quality and accuracy initiatives that enhance appeal outcomes and improve member and provider experiences. Qualifications Required Qualifications - 3+ years of experience in claims analysis, pricing, reimbursement, or related healthcare operations role. - Strong analytical and problem-solving skills, with the ability to assess complex data and make sound recommendations. - Experience working in fast-paced environments requiring prioritization, independent decision-making, and attention to detail. - Strong written and verbal communication skills, with the ability to explain pricing decisions clearly and professionally. - Proficiency with Microsoft Office tools, including Excel, Word, PowerPoint, and SharePoint. Preferred Qualifications - Knowledge of healthcare claim payment methodologies and reimbursement practices. - Experience with claims systems such as Proclaim, PMHS, Facets, or SANP. - Experience supporting pricing strategy, appeals, or reimbursement analysis. 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 66,300 - 110,500 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.

At U.S. Bank, we’re on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions, enabling the communities we support to grow and succeed in the right ways, all more confidently and more often—that’s what we call the courage to thrive. We believe it takes all of us to bring our shared ambition to life, and each person is unique in their potential. A career with U.S. Bank gives you a wide, ever-growing range of opportunities to discover what makes you thrive. Try new things, learn new skills and discover what you excel at—all from Day One. As a wholly owned subsidiary of U.S. Bank, Elavon is committed to building the platforms and ecosystems that help over 1.5 million customers around the world to achieve their financial goals—no matter what they need. From transaction processing to customer service, to driving innovation and launching new products, we’re building a range of tailored payment solutions powered by the latest technology. As part of our team, you can explore what motivates and energizes your career goals: partnering with our customers, our communities, and each other. We actively uphold transparent and fair hiring practices that support individual opportunity, inclusive culture, and career mobility across all levels of our organisation. We offer meaningful opportunities for growth, a culture of inclusion, and a strong commitment to transparency and integrity in everything we do. Job Description The Fraud Support Analyst provides operational and analytical support to fraud strategy, with a primary focus on system testing and issue resolution in partnership with vendors. This role is responsible for performing system testing and analysis, executing procedures and controls on owned systems, and ensuring all activities align with documented standards and established processes. Acting as the primary point of contact for system-related issues, the analyst monitors, tracks, and coordinates resolution efforts with internal stakeholders and external vendors. The role partners closely with stakeholders, team members, and management to resolve issues, improve processes, maintain strong operational controls, communicate system status, performance, and risks to support the bank’s fraud risk capabilities. Key Responsibilities · Perform system testing and analysis to support fraud platforms and ensure functionality aligns with documented requirements, approved standards and regulatory expectations. · Execute and monitor operational procedures and controls on assigned systems to ensure compliance, accuracy, and audit readiness. · Serve as the primary point of contact for system-related issues, including identification, tracking, escalation, and resolution. · Partner with internal stakeholders and external vendors to coordinate issue resolution, communicate impacts, and drive timely outcomes. · Own vendor-related issues by tracking progress, and ensuring closure in accordance with established processes. · Maintain accurate documentation for system changes, testing, issue resolution, and operational procedures. · Act as a liaison between stakeholders, team members, and management to communicate system status, performance, risks, and issues. · Support initiatives to improve processes, strengthen operational controls, and enhance the bank’s fraud risk capabilities. · Participate in cross-functional meetings and working sessions to ensure alignment, transparency, and continuous improvement. Basic Qualifications - Bachelor’s or equivalent work experience - Three to five years of related experience, this includes testing experience - Ability to manage multiple tasks/projects and deadlines simultaneously - Ability to work as part of a project team - Proficient computer skills, especially Microsoft Office applications and data analysis software This role is designated as U.S. home-based remote. working hours: 2pm-10pm Accessibility We are committed to providing an inclusive and accessible recruitment experience. If you need adjustments at any stage of the application or hiring process, please contact your recruiter for guidance and support. Total Rewards U.S. Bank is committed to fair, equitable, and transparent compensation practices in line with local regulatory and legal requirements. Our total rewards approach is designed to attract, retain, and support top talent while ensuring equal pay for work of equal value. We offer a market-competitive compensation package that includes: - Clearly defined salary ranges aligned with industry benchmarks and internal equity standards. - Performance-based incentives for eligible employees (as defined by relevant plan rules), awarded through transparent, objective criteria that recognize both individual and company performance. - Inclusive equitable benefits that are accessible to all employees and focused around our 3 main pillars of financial wellbeing, health & wellness). - Continuous development opportunities including training, education support, and career progression pathways based on inclusive and transparent criteria. - Employee recognition programs that celebrate achievements and milestones for all. We regularly review our compensation and benefits to ensure they remain competitive, inclusive, and responsive to employee needs and market trends. Further details of the compensation package will be provided upon application. We encourage candidates to explore the full value of our offer, including monetary and non-monetary benefits, at Employee benefits and development | U.S. Bank | Elavon. Closing Date Posting may be closed earlier due to high volume of applicants. We aim to provide timely updates throughout the process and encourage early applications to ensure consideration.

This is a remote position. We are seeking an experienced Facets Configuration Analyst to support the configuration, maintenance, and optimization of the Facets platform. This role is responsible for ensuring accurate claims adjudication by building and maintaining system rules, benefit plans, and operational parameters in alignment with business and regulatory requirements. Key Responsibilities: - Configure and maintain Facets system rules, benefits, and parameters to support claims processing and operational workflows - Ensure accurate and compliant claims adjudication through proper system configuration - Translate business and regulatory requirements into effective system solutions - Analyze and troubleshoot configuration issues, identifying root causes and implementing resolutions - Collaborate with cross-functional teams including operations, compliance, and IT to support system updates and enhancements - Maintain documentation related to configurations, processes, and system changes - Support ongoing system optimization and performance improvements Requirements Required Qualifications: - Minimum of 5 years of hands-on experience with the Facets platform - At least 3 years of experience working with CMS work products, including Medicare Advantage (MA) or Medicaid - Proficiency in a minimum of three Facets modules, including Facets Medical Plan - Experience working with Facets version 25.1 or newer - Strong understanding of healthcare payer operations and claims adjudication processes - Excellent communication skills, both written and verbal

Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. Independence American Insurance Co is seeking a Carrier Operations Fraud Analyst who will report to the Director, Carrier Operations. The Carrier Operations Fraud Analyst is responsible for managing and overseeing the Special Investigations Unit (SIU) program for IAIC and IPIC, ensuring compliance with state regulations and filed fraud plan. This role leads fraud investigations, coordinates reporting and required audits, and develops processes to detect and prevent fraudulent activity. The analyst collaborates with internal teams, administrators, and state regulators to maintain program integrity, drive continuous improvement, and support operational compliance. Job Location: Remote – USA Main Responsibilities: - Lead fraud investigations of referrals; report referrals to regulatory bodies and assist state investigators with requests. - Manage annual SIU reporting requirements for the IPH carriers; submit reports to state regulatory bodies. - Collaborate with administrators to proactively detect fraud, analyze trends, and escalate emerging concerns. - Oversee SIU program operations, collaborate with Director of Carrier Operations and administrators to evaluate processes, workflows, and key risk indicators (KRIs). - Collaborate with DOI law enforcement on fraud investigations and case development. - Create and maintain monthly fraud reporting for carrier leadership. - Facilitate SIU Committee meetings; prepare agendas, present fraud referrals - Facilitate fraud meetings internally and with administrators; prepare agendas, share trends, schemes, and fraud activity. - Ensure completion of DOI-mandated annual fraud training for all SIU employees; manage distribution, follow-ups, certificate collection, and maintain logs for state submission. - Audit administrators and carrier employees annually to confirm fraud training adherence; work with HR and management to resolve gaps. - Maintain and update carrier fraud training programs to meet state requirements, coordinate scheduling and delivery with HR. - Build and maintain fraud-related workflows and handoffs between carrier and administrators. - Develop and maintain process documentation, procedures, and carrier guidelines; provide to states as needed. - Maintain and update fraud plans and organizational charts for carriers; ensure annual review and filing with states. - Create and manage documentation and logs for referrals and investigations. - Create notices and cancellation letters for policyholders and other required parties. - Conduct administrator audits to validate adherence to fraud processes, filed fraud plan and state requirements. - Collaborate with leadership to identify process improvements and drive efficiencies across fraud detection and reporting. - Provide backup support to other areas in the Carrier Operations department. - Performs other duties and responsibilities as assigned. Basic Qualifications: - Bachelor’s degree in Business, Insurance, Criminal Justice, or related field preferred. - Minimum of 3 years of experience in insurance operations, fraud investigation, or compliance. - Strong understanding of insurance operations, regulatory standards, and compliance requirements. - Claims and claims data analysis experience is a plus. - Experience with state fraud reporting, audits, and fraud investigation. - Familiarity working with state investigators highly desirable. - Experience developing workflows, processes, and training programs preferred. - Strong understanding of operations, insurance fraud detection, SIU requirements, and regulatory compliance. - Excellent investigative and analytical skills with attention to detail. - Strong organizational and project management abilities. - Ability to interpret and apply state regulations related to fraud and SIU programs. - Proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint). - Strong written and verbal communication skills; ability to present complex fraud cases clearly. Expected Hours of Work: - This is a full-time position: Days and hours to be determined by needs of business. Hours to be determined between employee and director #li-Remote All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: - Comprehensive full medical, dental and vision Insurance - Basic Life Insurance at no cost to the employee - Company paid short-term and long-term disability - 12 weeks of 100% paid Parental Leave - Health Savings Account (HSA) - Flexible Spending Accounts (FSA) - Retirement savings plan - Personal Paid Time Off - Paid holidays and company-wide Wellness Day off - Paid time off to volunteer at nonprofit organizations - Pet friendly office environment - Commuter Benefits - Group Pet Insurance - On the job training and skills development - Employee Assistance Program (EAP) Interview Technology Notice: Please note that phone and video interviews or screenings may be recorded and transcribed using interview technology to support our recruitment process. By continuing with the interview, you consent to this use. Text Messaging Notice: If you provide a mobile phone number, you may receive job-related communications via text message. Message and data rates may apply. You may opt out of text communications at any time by replying “STOP.”