Operating Effectiveness Senior Analyst - EviCore - Remote

The Operating Effectiveness Senior Analyst serves as a critical link between clinical operations, business processes, technology, and decision support systems. This role designs, implements, and optimizes clinical and operational workflows, business rules, algorithms, and automated decision-support solutions that enable scalable, efficient, and compliant utilization management programs. The analyst translates complex business and clinical requirements into system logic, pathways, and AI-enabled workflows that improve decision quality, operational efficiency, user experience, and organizational scalability. Responsibilities include pathway development, algorithm configuration, process improvement, quality assurance, root cause analysis, workflow optimization, and collaboration with clinical, operational, product, and technology teams.

Key Responsibilities

• Design, develop, maintain, and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows that enable consistent, accurate, and scalable operational outcomes.
• Translate clinical guidelines, business requirements, regulatory standards, and client needs into system logic, workflow configurations, and decision-support solutions.
• Partner with Clinical, Operations, Product, Technology, Data, and Business stakeholders to identify opportunities for automation, AI integration, workflow simplification, and operational effectiveness improvements.
• Leverage data analysis, critical thinking, and root cause methodologies to resolve operational issues, improve outcomes, and drive continuous process improvement initiatives
• Develop scalable solutions that enhance clinical decision-making, automated rationale generation, letter production, utilization management operations, and user experiences
• Conduct functional, regression, and quality assurance testing to ensure accuracy, compliance, performance, and reliability of implemented solutions.
• Monitor system performance, user feedback, and operational metrics to identify enhancement opportunities and optimize decision-support workflows.
• Create and maintain process documentation, standard operating procedures, workflow diagrams, training materials, and governance controls.
• Support implementation of new programs, enhancements, and enterprise initiatives through testing, training, deployment, and change management activities.
• Ensure solutions align with regulatory, accreditation, compliance, privacy, and quality standards including HIPAA, NCQA, and URAC requirements.
• Utilize reporting, analytics, and emerging AI technologies to identify insights, improve decision accuracy, reduce manual effort, and increase operational scalability.

Qualifications

• Bachelor's degree in Science, Healthcare Administration, Computer Science, Data Analytics, Mathematics, Information Systems, or a related field, or equivalent experience.
• Experience in healthcare operations, utilization management, clinical decision support, product operations, process improvement, or business systems analysis.
• Strong analytical, problem-solving, communication, and stakeholder management skills.
• Experience translating business requirements into workflows, decision logic, pathways, algorithms, or system configurations.  
• Knowledge of workflow design tools, business rules engines, Visio, SharePoint, Tableau, SQL, Databricks, or similar analytics and process automation technologies preferred
• Experience supporting AI-enabled solutions, automation initiatives, intelligent workflow platforms, or decision-support technologies preferred.
• Ability to balance operational execution with strategic thinking, innovation, and continuous improvement.

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 63,400 - 105,600 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.