Remote Risk Adjustment Coder Jobs in Durham, NC (NOW HIRING)

Help shape how healthcare risk decisions are made.

At The Cigna Group, pricing and underwriting decisions rely on data-driven insights that are accurate, explainable, and operationally reliable. As the Data Science Director for Pricing & Underwriting, you will lead high-impact teams that build and evolve machine learning models influencing business growth, risk selection, forecasting accuracy, and underwriting effectiveness. This is an opportunity to combine technical excellence, strategic leadership, and business partnership to deliver meaningful outcomes across a complex healthcare environment.

Responsibilities

• Lead the strategy, development, enhancement, and support of machine learning models that enable pricing, underwriting, risk scoring, presale, and renewal decision-making.

• Establish and continuously improve model lifecycle practices, including development, validation, monitoring, documentation, governance, release management, and model refresh processes.

• Provide technical leadership across machine learning, statistical modeling, feature engineering, model evaluation, calibration, explainability, and production-ready analytics.

• Drive execution across multiple model products by prioritizing work, managing delivery plans, coordinating releases, and ensuring reliable production support.

• Partner with pricing, underwriting, actuarial, sales, finance, technology, data engineering, and governance teams to embed model outputs into business processes and decision frameworks.

• Translate complex analytical concepts into clear business insights, helping stakeholders understand model performance, limitations, opportunities, and risks.

• Ensure compliance with model governance, audit, documentation, and monitoring requirements while maintaining high standards for quality and operational reliability.

• Build and develop a high-performing data science organization through coaching, talent development, collaboration, accountability, and continuous improvement.

Required Qualifications

• 10+ years of experience in data science, advanced analytics, statistical modeling, machine learning, actuarial analytics, or a related quantitative field.

• 5+ years of experience leading and developing technical teams responsible for production-grade analytics or machine learning solutions.

• Strong expertise in machine learning, statistical modeling, model monitoring, validation, and explainability techniques.

• Hands-on experience with Python, SQL, Git, and modern analytics development practices.

• Experience managing model lifecycle processes, including governance, documentation, monitoring, testing, and production support.

• Demonstrated ability to influence senior business and technical stakeholders and translate complex analytical findings into actionable business decisions.

Preferred Qualifications

• Experience with healthcare payer data, claims analytics, pricing, underwriting, risk adjustment, actuarial analytics, or other risk-focused domains.

• Experience with Databricks, Spark, cloud-based analytics platforms, or large-scale data environments.

• Advanced degree in Data Science, Statistics, Computer Science, Mathematics, Engineering, Actuarial Science, or a related quantitative discipline.

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 178,500 - 297,500 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 and long term incentive 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 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.