Complaint & Clinical Policy Advisor - Md Live - Hybrid

The Cigna Group

Multiple Locations
Base: 95,500 - 159,100 usd / yearly; bonus/equity:...
Complaint lifecycle management
Clinical policy development
Root cause analysis
Own the end-to-end medical complaint lifecycle, ensuring timely, high-quality responses and sustainable corrective actions

Job Summary

  • Own the end-to-end medical complaint lifecycle, ensuring timely, high-quality responses and sustainable corrective actions.
  • Support clinical policy governance across service lines, partnering with stakeholders to develop, harmonize, and maintain evidence-based clinical policies.
  • The Cigna Group offers a comprehensive range of benefits, including medical, vision, dental, well-being programs, 401(k), tuition reimbursement, and a minimum of 18 days of paid time off per year.

Matching Summary

Own the end-to-end medical complaint lifecycle, ensuring timely, high-quality responses and sustainable corrective actions.

Salary

Base: 95,500 - 159,100 USD / yearly; Bonus/Equity: Annual bonus plan; Benefits: Comprehensive range of benefits including medical, vision, dental, well-being programs, 401(k), tuition reimbursement, 18+ days PTO, paid holidays

Skills & Requirements

Must-have

  • Complaint lifecycle management
  • Clinical policy development
  • Root cause analysis
  • Service recovery
  • Data integrity and reporting
  • Policy education and training

Nice-to-have

  • Elite service mindset
  • Adaptable and collaborative approach
  • Fast-paced dynamic environment
  • Continuous improvement focus

Key Requirements

  • Bachelor's degree required
  • Project management or process improvement experience required
  • 2+ years clinical policy experience
  • 5+ years healthcare experience
  • Experience with C360 preferred
  • Experience with SAIGlobal, Tableau, Microsoft Office
  • Experience with commercial EMR systems

Work Rights

Not specified

Tailored Resume

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