Senior Provider Compliance & Risk Analyst

Cigna Healthcare; United States; Remote; USD 62,000 - 104,000; Full time

Benefits offered by this job

Annual bonus eligible

Health benefits

401(k)

Life insurance

Tuition reimbursement

Paid time off (18 days)

Paid holidays

Leaves of absence

Job summary

Cigna Healthcare’s Evernorth Health Services division seeks a compliance-focused professional to strengthen pharmacy network oversight and improve client/member experiences. You will tackle complex regulatory and operational challenges, partnering across teams to implement data-driven solutions.

The role emphasizes analyzing risks, designing business applications, and driving continuous improvement while ensuring adherence to state and federal rules.

Qualifications

• 3+ years of experience in pharmacy benefit management, pharmacy networks, healthcare operations, compliance, or related field.
• Strong analytical, critical-thinking, problem-solving, and decision-making skills.
• Ability to manage multiple priorities, deadlines, and deliverables in a fast-paced environment.
• Clear written and verbal communication skills for cross-level collaboration.
• Excellent organization, time management, attention to detail, and sound judgment.

Responsibilities

• Partner with contracted pharmacy providers and internal teams to research and resolve complex compliance and operational matters.
• Lead or contribute to cross-functional projects that design, test, and implement business applications, technology solutions, and process improvements.
• Analyze complex issues, identify risks and opportunities, and turn findings into clear, timely recommendations and solutions.
• Improve processes by simplifying work, automating workflows, and strengthening alignment across teams and partners.
• Monitor network provider compliance with applicable state and federal requirements, internal policies, and established procedures.
• Support client, internal, and other applicable audits by preparing information, coordinating responses, and addressing operational needs.
• Create, review, and maintain standard operating procedures, policies, training materials, and other process documentation.
• Share recommendations, concerns, and operational risks with the right stakeholders while building trusted cross-functional relationships.
• Promote operational excellence through continuous improvement, effective use of technology, and consistent execution.

Skills

Analytical thinking

Critical thinking

Problem solving

Decision making

Communication

Time management

Attention to detail

Prioritization

Education

Bachelor’s degree

Tools

Microsoft Excel

PowerPoint

Word

Access

Job description

Cigna Healthcare’s Evernorth Health Services division seeks a compliance-focused professional to strengthen pharmacy network oversight and improve client/member experiences. You will tackle complex regulatory and operational challenges, partnering across teams to implement data-driven solutions.

The role emphasizes analyzing risks, designing business applications, and driving continuous improvement while ensuring adherence to state and federal rules.