Healthcare management h1.location_city

Description

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The Program Management Senior Advisor (an individual contributor role) is a senior operational leader responsible for ensuring the accurate, compliant, and high‑quality execution of regulatory‑driven benefits alignment across reimbursement rules, prior authorization, and medical policy implementation. This role translates complex regulatory, legal, product, and policy requirements into disciplined execution, bringing structure to ambiguity and driving coordinated delivery across highly matrixed, cross‑functional teams. Additional responsibilities will include Vendor Management, facilitation of proof-of-concept initiatives, and vendor process oversight.

Serving as a central liaison for the Payment Integrity team, the Senior Advisor manages regulatory questions and inquiries; coordinates the timely collection of required information; and ensures responses and implementations meet legal, regulatory, quality, and documentation standards. With a strong emphasis on quality, accuracy, and alignment, this role acts as a trusted execution advisor—proactively identifying risks, resolving misalignments between products, policy, and systems, and ensuring outcomes are correct, sustainable, and audit‑ready. This role will also coordinate the exploration and attainment of vendor partnerships to expedite process and onboard new capabilities to the team.

Key Responsibilities

• Lead operational program management for complex, cross‑functional initiatives supporting state and federal mandate implementation and code‑to‑benefit alignment
• Translate regulatory, legal, and policy requirements into clear execution plans, milestones, controls, and evidence artifacts that ensure accurate, compliant, and timely implementation
• Serve as the primary liaison for the Payment Integrity team, handling regulatory questions, inquiries, coordinating the timely collection, validation, and organization of required information across internal stakeholders
• Provide quality and accuracy oversight across programs and implementations, establishing checkpoints, readiness reviews, and validation processes to ensure outcomes are correct, consistent, and audit‑ready
• Ensure alignment between products, services, medical policy, reimbursement logic, and system coding, proactively identifying and resolving misalignments that could impact compliance, financial integrity, or customer/client and/or provider experience
• Partner closely with Legal, Compliance, Product, Policy, Operations, Technology, Vendor and Finance teams to drive coordinated execution across a highly matrixed environment
• Establish and maintain operating process, artifacts, and senior leadership‑level reporting to provide transparency into progress, risks, issues, and decisions
• Analyze implementation outcomes, quality data and inquiries to identify systemic issues, root causes, and emerging risks, driving corrective and preventative actions
• Develop and maintain clear documentation, reference materials, and guidance to support consistent understanding and application of benefit alignment, regulatory, policy, and product requirements
• Act as a trusted execution advisor and escalation point, bringing structure to ambiguity, balancing regulatory intent with operational realities, and driving disciplined follow‑through

Qualifications

• Bachelor's degree or higher strongly preferred or equivalent work experience required
• 10+ years working in insurance, healthcare or another regulated industry
• Active AAPC or AHIMA coding certification (e.g., CPC, CPCO, RHIT, CCS-P, CIC, COC) and at least 10 years of HCPCS/CPT coding experience highly preferred
• 7+ years of program/product management experience in complex, regulated environments
• Strong grasp of regulatory operations; able to implement mandates, handle audits, inquiries, and disputes
• Skilled in leading cross-functional projects across Legal, Compliance, Product, Policy, Operations, Tech, and Vendors
• Experience with benefit configuration or code alignment tasks
• Track record in quality oversight, readiness reviews, validation, issue resolution, and audit support
• Able to coordinate responses for complex issues and manage escalations
• Strong analytical skills: root cause analysis, risk assessment, and corrective actions
• Excellent written and verbal communication; capable of producing executive-level and regulator-facing documents
• Experience developing policies, procedures, references, or training in regulated settings
• Proven ability to work independently, prioritize, and achieve results with minimal guidance
• Proficiency in Microsoft Office, Tableau, EncoderPro, and Wrike

Key Competencies

• Program & Project Management – Leading complex initiatives with structured planning and delivery
• Quality & Accuracy Oversight – Ensuring consistency and accuracy in implementations
• Product, Policy & Code Alignment – Coordinating product, policy, and coding requirements
• Regulatory Liaison & Issue Resolution – Handling regulatory queries and escalations professionally
• Cross-Functional Influence – Achieving results across teams without direct authority
• Analytical Problem Solving – Diagnosing issues and implementing solutions
• Executive Communication – Providing concise updates and recommendations to leadership

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 116,100 - 193,500 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, .

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.