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Cigna Installation & Data Quality Director in Plano, Texas

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Installation and Data Quality Director

The Government Business Segment Installation and Data Quality (IDQ) Director is a senior leadership role within Cigna HealthSpring’s (C-HS) Customer & Client Service Experience (CCSE) Organization. This role will support the Medicare (i.e. Individual & EGWP MAPD & PDP), Medicaid, and CareAllies lines of business by directly managing the Provider Data Management (i.e. Provider Demographics and Contract Configuration), Network Operations Support (i.e. P&Ps, Provider Communications, Provider Directories, Provider Data Accuracy, Network Adequacy), and User Acceptance Testing (UAT) of benefit and provider contract configuration changes, as well as of other operational functions. This role will be responsible for the oversight of matrixed functions including IT Configuration, Provider Data Validation, and Credentialing. The IDQ Director will report directly to the Operations Managing Director overseeing CCSE.

To drive to the experience and outcomes that C-HS’s desires for its customers and key provider partners, it is imperative that the underlying data that drives operational outcomes is current and accurate. The primary responsibilities of this role are to direct strategic and operational activities associated with managing and maintaining provider data and configuration changes for our regulated business (Medicare Advantage, Medicaid, Pharmacy, etc.), to work with matrix partners to improve provider data quality where changes primarily occur (i.e. C-HS’s markets), and to ensure that the front-end processes for installing provider data, configuring new benefits and benefits changes, and testing configuration changes are aligned with and support downstream operational objectives such as improved rates of auto-adjudication. This role will require the candidate to engage and motivate a large team of people with diverse skills, responsibilities and geographic locations, and to drive collaboration with matrix partners (e.g. Product Development, IT, Compliance, Market Leads, Network Operations) to understand and deliver upon our commitments to our beneficiaries, providers, CMS, and State Agencies.

Responsibilities:

  • Strengthen and manage connections within the IDQ Operations team and with key matrix partners including Product Development, Information Technology, Compliance, Market Leadership and Network Operations.

  • Direct the IDQ Operations activities for CCSE ensuring compliance with organization and regulatory policies.

  • Improve quality such that the IDQ team consistently meets or exceeds goals for accuracy, timeliness, and regulatory compliance for all department functions.

  • Ensure that the IDQ team meets all deliverables and milestones supporting the Annual Readiness process for Medicare and Medicaid.

  • Review IDQ’s systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals.

  • Review upstream and downstream systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals and to improve customer and provider experiences.

  • Understand and share business controls and information across CCSE; ensure that there is clear understanding and ownership of key scorecard measurements as well as of total quality measures and initiatives.

  • Evaluate marketplace opportunities to improve our effectiveness (Cost and Quality).

  • Utilize information technology tools and techniques for organizing, analyzing and interpreting data to solve specific issues with an initial focus on quality and cost.

  • Build understanding and awareness of product strategies and assess operational impact readiness to support as applicable.

  • Implement methods to better utilize customer and provider data to measure our level of success and identify improvement opportunities.

  • Develop a team of people that can lead the organization into the future, supply future leaders to other parts of the organization, and think differently about how we do business.

  • Enable a virtual work environment where managers and employees have the tools, resources, and information necessary for teamwork, productivity and engagement.

Qualifications:

  • BA/BS in Business or related field preferred.

  • 8+ years of large-scale/high volume operations management within the Medicare/Medicaid industry experience required.

  • Strong knowledge of Network Operations, Claim Operations, and benefit configuration/testing preferred.

  • A minimum 5 years of prior direct people management experience with demonstrated results in leading and developing a team of people required. Experience managing a team of managers and virtual management experience strongly preferred.

  • Innovative, strategic and creative thinking skills with a focus on continuous process improvement is required.

  • Highly collaborative individual with the ability to drive change and influence within a cross-functional matrix team environment.

  • Strong communication skills; written, oral and listening skills. Location & Travel : Nashville (preferred), Phoenix, Houston, Dallas, Birmingham, Miami and Work at Home; Up to 25% travel required.

Qualified applicants will be considered without regard to race, color, age, disability, sex (including pregnancy), childbirth 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 require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

We’re a global health service company dedicated to helping people improve their health, well-being and sense of security. We offer an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products that serve over 95 million customers around the world. When you work with us, you’ll enjoy a different kind of career - you’ll make a difference, learn a ton, and change the way people think about health insurance. To see our culture in action, search #TeamCigna on Twitter or Instagram.

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