Product Management Senior Advisor - Medicaid Encounter Operations

Make an Impact on Healthcare Outcomes

Are you a problem solver who enjoys turning complex data into meaningful results? As a Product Management Senior Advisor, you will play a key role in ensuring accurate and timely Medicaid encounter submissions that support state compliance requirements and client expectations. In this role, you will partner across teams, influence process improvements, and provide trusted expertise that helps drive operational excellence. If you are energized by collaboration, continuous improvement, and making a measurable impact, we'd love to hear from you.

Responsibilities

• Drive the success of Medicaid encounter operations by monitoring submission processes, identifying risks, and ensuring accurate and compliant file delivery to states and clients.
• Analyze trends, performance metrics, and operational data to identify opportunities for improvement and recommend solutions that strengthen outcomes.
• Investigate encounter rejections, perform root cause analysis, and lead remediation efforts in alignment with state guidance and regulatory requirements.
• Translate data and findings into actionable recommendations that support leadership decision-making and business priorities.
• Partner with cross-functional teams to improve processes, enhance operational efficiency, and support strategic initiatives.
• Develop and maintain business documentation that supports compliance monitoring, process execution, and communication of client impacts.
• Serve as a subject matter expert for Medicaid encounter processes, providing guidance and education to internal stakeholders, account teams, and clients.
• Build strong client and partner relationships by delivering clear updates, addressing questions, resolving issues, and managing expectations through timely follow-up.
• Support client and state-facing discussions by communicating process status, performance results, and ongoing improvement efforts.
• Contribute to achieving performance goals, compliance metrics, and service commitments while fostering a culture of continuous improvement.

Qualifications

Required Qualifications

• 5+ years of professional experience in business analysis, healthcare operations, compliance, product management support, or a related field.
• Strong analytical skills with the ability to interpret large data sets, identify trends, uncover root causes, and develop actionable recommendations.
• Advanced proficiency in Microsoft Excel and other Microsoft Office applications.
• Experience gathering, analyzing, and validating data from multiple systems and sources.
• Demonstrated ability to work effectively across functions and influence outcomes through collaboration.
• Strong written and verbal communication skills, including experience presenting information to diverse audiences.
• Customer-focused mindset with a commitment to delivering high-quality service and operational excellence.
• Ability to balance detailed execution while supporting broader strategic objectives.

Preferred Qualifications

• Experience within the pharmacy benefit management (PBM), healthcare, managed care, or health services industry.
• Experience supporting Medicaid programs, encounter operations, claims processing, or healthcare compliance activities.
• Knowledge of state and federal healthcare regulations.
• Experience working directly with clients, account teams, or external stakeholders.
• Experience using Tableau, SQL, or other reporting and data visualization tools.
• Bachelor's degree or equivalent practical experience.
• Demonstrated success leading process improvement initiatives and driving operational efficiencies.
• Self-starter who thrives in a fast-paced environment and embraces continuous learning and growth.

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 113,200 - 188,600 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, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.