Remote Cigna Claims Representative Jobs in Raleigh, NC

Summary
Using your knowledge of statistics, healthcare, and ML / AI you will build models to help identify opportunities for our pricing and underwriting partners. You will perform feature engineering, model development, and model monitoring / maintenance using a broad range of medical, prescription drug, utilization management, and third-party data. In this role you will work closely with leadership, data scientists, business stakeholders and engineering partners to deliver robust well-documented deliverables that will enhance our competitive position in the marketplace.
Responsibilities

• Contribute to the development of comprehensive analytics that facilitate best in class pricing and underwriting
• Execute special projects that can improve Commercial Healthcare underwriting
• Utilize data science and advanced analytics to create actionable insights and recommendations for business leaders to advance Cigna's strategic objectives
• Regularly communicate work with business stakeholders and senior leadership
• Stay up to date on latest analytic tools and techniques and strategize how to leverage these tools to modernize our pricing/UW organizations
• Ensure solutions drive long term value while also ensuring they can integrate with current processes
• Test & Learn Pilots: collaborate with business leaders to design, launch and measure robust pilots to test new solutions
• Develop models that foster underwriting and actuarial advancement by aligning business problems to a potential solution like GLMs, Machine Learning, Clustering, LLMs or other advanced techniques

Qualifications:

• 5+ years direct Data Science experience in a healthcare related environment
• Strong background in stats, ML and model development
• Experience deploying ML/predictive models to prod/cloud env't
• Strong skills with Python, SQL, Git, Keras and TensorFlow
• Knowledge of common health care data e.g., claims, EHR, laboratory data
• Experience with best programming practices and writes clean, documented, and well-structured code
• Ability to peer review
• Champions a culture of documentation and logging
• Ability to own a project end-to-end e.g., scoping, ideation, dev, prod
• Ability to independently deliver clear and well developed presentations for both technical and business audiences
• Ability to create DS-specific project goals associated within high level project deliverables
• Ability to articulate timeline changes, rationale, and goals to meet deadlines moving forward
• Prefer MS or PhD in STEM related fields

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 131,200 - 218,600 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 and paid holidays. For more details on our employee benefits programs, click here.
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 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.