Continuous Improvement Sr. Advisor- Prior Authorization

The Senior Continuous Improvement / Business Process Engineer plays a key role in improving how healthcare call center and claims operations this role youll lead complex crossfunctional initiatives take on ambiguous enterprisewide challenges and deliver meaningful measurable improvements through smarter processes datadriven insights and automation.

Responsibilities

Process Improvement & Operational Excellence
Identify and frame high value improvement opportunities defining problems to solve based on business value risk and scalabilitynot solely assigned initiatives
Lead end to end improvement initiatives across functions and teams from problem definition through implementation adoption and sustainability
Navigate high complexity environments with competing priorities unclear requirements and multiple stakeholders
Quantify validate and track benefits including cost savings capacity creation quality improvement and risk reduction ensuring value realization is achieved and sustained
Serve as a change leader addressing resistance aligning stakeholders and ensuring improvements stick beyond implementation

Business Process Engineering & Documentation
Lead enterprise level current state and future state process design spanning multiple functions handoffs and systems
Facilitate complex working sessions to uncover root causes systemic constraints and interdependencies
Redesign and standardize processes to improve clarity consistency scalability and operational readiness
Translate complex workflows into clear consumable artifacts tailored for frontline teams operational leaders and executives
Establish and evolve process standards in partnership with business and technology leaders

Automation AI & Technology Enablement
Proactively integrate automation AI and product thinking into improvement solutions rather than treating automation as a downstream add on
Evaluate operational feasibility change impact and scalability of proposed solutions
Partner with technology product and automation teams to shape solutions that balance speed risk and long term sustainability
Contribute to business cases by clearly articulating expected benefits tradeoffs and implementation considerations
Support requirements definition testing strategy and implementation readiness as needed

Data Analysis Measurement & Insight Generation
Use data to identify opportunities validate hypotheses and inform prioritization decisions
Define success metrics upfront and own ongoing benefit validation and reporting
Translate complex data into clear actionable recommendations for senior operational leaders
Ensure measurement approaches support enterprise level decision making not just project reporting

Stakeholder Partnership Influence & Leadership
Serve as a trusted improvement partner to directors VPs frontline leaders technology partners and external vendors
Make and own strategic and tactical decisions within initiatives escalating only when appropriate
Influence outcomes through credibility judgment and strategic framing not positional authority
Coordinate multiple initiatives and teams simultaneously aligning work to enterprise priorities
Mentor and coach junior CI/BPE practitioners raising overall CI maturity and capability across the organization

Success Measures
Demonstrated enterpriselevel cost savings capacity creation or risk reduction
Sustainable adoption of improvements with clear operational ownership
Reduction in manual effort rework and cycle time across multiple processes
Measurable value realization tied to defined success metrics
Successful integration of automation and AI into operational workflows
Strong executive leader trust satisfaction and repeat engagement

Qualifications

• Minimum of 8 years experience in continuous improvement process engineering or operational excellence
• High School Diploma required Bachelors Degree preferred
• Proven ability to own and lead ambiguous crossfunctional initiatives to measurable outcomesAdvanced application of Lean and/or Six Sigma methodologies including adapting approaches to fit business context
• Strong endtoend process mapping redesign and documentation skills
• Datadriven decisionmaker with experience defining and validating benefits (Excel required; BI/SQL a plus)
• Demonstrated ability to influence senior stakeholders without formal authority
• Preferred
• Healthcare pharmacy claims processing or call center operations experience
• Prior authorization or utilization management exposure
• Experience integrating or supporting automation workflow tools RPA or AI solutions
• Familiarity with generative AI or emerging automation technologies
• Proficiency with Visio SharePoint Confluence or similar documentation platforms
  

Candidates who reside within 50 miles of the following locations may be asked to work in person on a hybrid schedule (three days per week): Bloomfield CT Chattanooga TN Denver CO St Louis MO or Scottsdale AZ.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group youll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment youll 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

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 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.