Provider Data Lead Representative - Evernorth - Remote

UnitedHealth Group; United States; Remote; USD 33,000 - 50,000; Full time

Job summary

The Cigna Group is seeking a Provider Data Lead Representative to ensure accurate maintenance and integrity of provider data across core systems including HCPM, CPF, and Facets. You will resolve fallout from claims, demographics, and contracts to enhance customer and provider experiences.

Responsibilities include data additions, terminations, and updates, data remediation, and applying contract terms. Collaboration within a team and adherence to quality standards are essential.

Qualifications

• High school diploma or GED is required; some college coursework preferred.

Responsibilities

• Execute provider data additions, terminations, and updates per procedures.
• Perform data remediation in HCPM, CPF, and Facets to maintain accuracy.
• Implement updates from quality audits to improve integrity.
• Apply contract terms and network rules for accurate data outcomes.
• Identify operational risks during data load and take corrective action.
• Validate data accuracy across systems and ensure transmission to downstream platforms.
• Conduct root cause analysis to diagnose issues and implement solutions.
• Analyze intake requests to assess impact and perform provider/network updates across systems.
• Adhere to production and quality standards, documenting in the Daily Activity Log (DAL).
• Support testing, validation, and checkout activities for system enhancements.
• Collaborate effectively within a team while maintaining accountability for results.

Skills

Data flow understanding

Contracts knowledge

System downstream impacts

Root cause analysis

Cross-system data validation

Education

High school diploma or GED

Some college coursework

Tools

CPF

HCPM

Proclaim

Facets

DAL

Inventory Manager

ETQS

Activity Manager

Provider Manager

Renaissance

Knowledge Exchange

Job description

Role Summary

The Provider Data Lead Representative is responsible for the accurate maintenance, correction, and integrity of provider data to support overall network quality. This role ensures that provider information is properly managed across core systems, including HCPM, CPF, and Facets, through timely updates, corrections, and terminations.

The position is also accountable for resolving claim, demographic, and contract-related fallout to prevent recurrence, enhance data accuracy, and improve the overall customer and provider experience.

Key Responsibilities

• Execute provider data additions, terminations, and updates in accordance with established procedures and business needs.
• Perform data remediation activities within HCPM, CPF, and Facets to maintain system accuracy and consistency.
• Implement updates identified through quality audits and performance analyses to improve data integrity.
• Apply contract terms and network business rules to ensure accurate and compliant data outcomes.
• Identify operational risks and issues encountered during data load processes and take appropriate corrective action.
• Validate data accuracy across multiple systems and ensure successful transmission to downstream platforms.
• Conduct root cause analysis to diagnose issues and implement solutions aligned with desired outcomes.
• Analyze intake requests from matrix partners to assess impact and execute appropriate provider, network, or criteria-level updates across systems.
• Adhere to established production and quality standards, including accurate and timely documentation in the Daily Activity Log (DAL).
• Support system enhancement initiatives by participating in testing, validation, and checkout activities as directed.
• Collaborate effectively within a team environment while maintaining accountability for individual contributions and results.

Qualifications

• High school diploma or GED required; some college coursework preferred.
• 2+ years of demonstrated proficiency using CPF and HCPM required (Proclaim and Facets preferred).
• Strong understanding of data flow and downstream system impacts.
• Knowledge of provider structures, including Practitioners, Groups, Facilities, and Ancillaries required.
• Solid understanding of contracts, networks, and applicable Market Guidebook standards is highly preferred.
• Working knowledge of tools such as DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, and Knowledge Exchange is highly preferred.

Competencies

Adaptability & Learning Agility

• Navigating Ambiguity – Demonstrates the ability to operate effectively in uncertain or evolving environments, exercising sound judgment and decision-making.
• Continuous Learning – Rapidly acquires, processes, and applies new information to meet changing business demands.

Problem Solving & Critical Thinking

• Analytical Problem Solving – Evaluates complex issues, identifies root causes, and implements practical, results-oriented solutions.
• Systems Thinking – Leverages organizational tools, processes, and systems to drive consistency, efficiency, and scalable outcomes.

Communication & Collaboration

• Effective Communication – Conveys information clearly and professionally, while actively listening to ensure alignment and shared understanding across stakeholders.

Execution & Productivity

• Time and Priority Management – Effectively organizes workload, prioritizes competing demands, and consistently meets deadlines.
• Resilience and Persistence – Maintains focus and determination in the face of challenges, driving tasks through to successful completion.

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 hourly rate of 24 - 36 USD / hourly, 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, paid holidays, and leaves of absence. For more details on our employee benefits programs.

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 [e-mail] 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.