Pre-Payment Vendor Operations & Edit Management Lead - Cigna Healthcare

About the position 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.

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
• 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

Requirements

• 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
• 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.

Nice-to-haves

• 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.

Benefits

• 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.

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