Cigna Jobs

This is a flex WAH/ Office role – we will consider someone in Bloomfield, CT, Morris Plains, NJ, Philadelphia, PA & Nashville, TN

The Client and Customer Service Operations (CCSO) Compliance Sr. Manager

This position is considered a leadership role and is accountable for leading a team of compliance professionals within the Commercial Compliance team. The Compliance Sr. Manager and team are responsible for implementing an effective compliance program tailored to the unique needs of these business areas. Working closely with the Business Segment leaders for CCSO, Commercial Compliance, Legal, Government Affairs, Vendors and other stakeholders, the CCSO Compliance Sr. Manager will provide Compliance and Regulatory oversight and support of ongoing operations, work with operational owners to develop and improve controls, and support new business projects and initiatives. Among other things, the CCSO Compliance Sr. Manager is responsible for ensuring that the aligned programs are in compliance with state and federal regulatory requirements. In addition, the CCSO Compliance Sr. Manager will also help ensure compliance with the Enterprise Compliance program, Privacy, Information Protection and Records Management programs.

KEY DUTIES AND RESPONSIBILITIES

• Partners with the US Commercial Compliance Director to implement and maintain an effective compliance program for the organization, including promoting culture of compliance and understanding of new and existing compliance issues and related policies and procedures;

• Monitors the performance of the Compliance Program and while taking appropriate steps to improve its effectiveness;

• Acts as an advisor to the business in all aspects of regulatory compliance (risk assessment, regulatory implementation, MCE activity and CAPS, etc.)

• Collaborates with other departments including the legal team, to direct compliance issues to appropriate existing channels for investigation and resolution;

• Responds to alleged violations of rules, regulations, policies and procedures, by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations;

• Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and resolved;

• Ensures business specific compliance training program meets the Compliance Program standards;

• Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends;

• Creates, executes and provides oversight of the testing and monitoring process on a continuing basis while taking appropriate steps to improve the overall effectiveness of the Compliance Program, including creating and updating compliance dashboards, metrics and reports and monitoring to ensure effective controls are in place within the ‘first line of defense” business operations;

• Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future; and

• Provides reports on a regular basis, and as directed or requested, to keep the key business stakeholders and senior management informed of the operation and progress of compliance efforts.

QUALIFICATIONS

• A bachelor’s degree; graduate degree and/or certification in healthcare compliance preferred;

• Must have 5+ years of experience in health care environment and a strong working knowledge of healthcare customer service operations, claim (par and non-par) and appeals processing;

• Compliance and/or privacy experience required;

• Excellent written and verbal communication skills across a variety of audiences;

• Management experience, and the ability to lead and manage a team of direct reports;

• Proven track record of project management, including effective leadership and on-time execution of the plan needed;

• Demonstrated ability to manage a high volume of work and lead a matrixed team or multiple projects and priorities;

• Strong, independent decision-making ability;

• Demonstrated attention to detail, ability to compile and analyze regulatory and business information, determine cost-/benefit, and provide resolutions or recommendations for process improvement;

• Ideal candidate will be a self-starter with a willingness to learn new areas of the business and regulatory needs to leverage their knowledge base to quickly come up to speed and operate at a senior manager level and/or as a subject matter expert;

• Highly collaborative individual with the ability to influence others and builds strong personal relationships; and

• Proficient in Microsoft Office Products (Power Point, Excel etc.)

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.

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.

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

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.