Program Management Senior Advisor - Cigna Healthcare - Remote
Candidates who reside within 50 miles of the following locations may be asked to work in person three days per week: Bloomfield, CT, Chattanooga, TN, Denver, CO, St Louis, MO, or Scottsdale, AZ.
Role Description:
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
• Profici
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Role Description:
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
• Profici
Apply tot his job
Apply To this Job