Pre-Payment Vendor Operations & Edit Management Lead - 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.

Payment Integrity - Program Management Senior Advisor

This role provides enterprise‑level leadership for pre‑payment vendor operations within the Payment Integrity organization. The Senior Program Advisor is accountable for vendor operations, contracting partnership, and lifecycle management to ensure vendors are selected, structured, and managed to deliver sustainable value at scale.

Role Purpose

Owns end‑to‑end pre‑payment vendor operations, contracting partnerships, and lifecycle management for prepay vendor programs. Ensures alignment of vendor capabilities with reimbursement methodologies, business goals, and regulatory expectations while minimizing financial, legal, and operational risk.

Key Responsibilities

• Lead vendor intake, evaluation, onboarding, contracting, performance oversight, and lifecycle management for pre‑pay programs
• Serve as the primary business partner to Legal for vendor agreements, risk terms, compliance provisions, and governance controls
• Apply deep Payment Integrity domain expertise to assess vendor edit models, analytics capabilities, and operational fit
• Leverage reimbursement methodology and claims knowledge to guide vendor selection and use‑case alignment
• Define, document, and maintain standardized vendor option sets by edit type and business need
• Partner with Product, Analytics, Operations, Finance, Compliance, and IT to support vendor strategy decisions
• Provide thought leadership on vendor risk, scalability, and long‑term sustainability aligned to the Integrity Select roadmap

Value to the Organization

• Establishes clear accountability and ownership for vendor decisions and associated risk
• Enables consistent, scalable, and standardized vendor selection across Payment Integrity programs
• Reduces legal, financial, and operational exposure through disciplined governance
• Ensures vendor operations align to long‑term enterprise and Integrity Select strategies

Qualifications

• Bachelor’s degree or higher strongly preferred or equivalent work experience required
• 10+ years of healthcare payer experience
• 7+ years of direct Payment Integrity vendor experience required
• Extensive experience with claim editing operations and reimbursement methodologies required
• Demonstrated experience with provider and vendor contracting, including risk‑based and performance‑based terms
• Broad Payment Integrity expertise including data mining, analytics‑driven recovery, DRG audits, claim editing, subrogation, COB, and pre‑pay/post‑pay programs required
• Proven ability to partner across Legal, Compliance, Contracting, Finance, Claims, Sales/Marketing, Analytics, and IT required
• Strong strategic, analytical, and independent decision‑making capability in a matrixed organization

Preferred Qualifications

• Advanced experience interpreting and applying legal concepts, policies, and healthcare payer regulations
• Prior ownership of enterprise vendor oversight models and internal lifecycle governance
• Experience defining enterprise‑wide vendor standards, operating models, or governance frameworks
• Background in financial and operational risk management related to vendor programs
• Demonstrated ability to influence executive‑level and senior leadership stakeholders
• Familiarity with federal and state regulatory requirements impacting Payment Integrity programs

This role operates with a high degree of autonomy and is expected to exercise sound judgment in alignment with enterprise policies and regulatory requirements.

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, click here.

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.