[Hiring] Reconciliation & Quality Advisor @The Cigna Group

Role Description

The Individual Dental Reconciliation and Quality Advisor has primary responsibility for Affordable Care Act Marketplace reconciliation supporting Individual Dental products. This role independently leads reconciliation strategy, execution, issue resolution, compliance readiness, vendor oversight, reporting, and cross-functional coordination. The Advisor also serves as an independent quality reviewer and trusted business advisor, assessing process execution, control effectiveness, data integrity, and remediation quality.

• Own end-to-end ACA Marketplace reconciliation for Individual Dental plans, including operational controls, file and transaction monitoring, discrepancy management, financial alignment, reporting, and issue escalation.
• Serve as the primary subject matter expert and accountable business contact for ACA Marketplace enrollment and policy-based payment reconciliation across Individual Dental Operations.
• Act as the primary enrollment-alignment contact for the Centers for Medicare & Medicaid Services.
• Independently research complex enrollment and financial discrepancies, determining root cause, business impact, resolution approach, and required corrective action.
• Develop trend analyses and actionable insights to improve reconciliation accuracy, reduce aging and resolution times, strengthen first-contact resolution, and prevent recurring issues.
• Use data-driven analysis to prioritize work, strengthen operational controls, improve data quality, reduce manual effort, and increase efficiency.

Qualifications

• Bachelor’s degree.
• At least five years of experience in healthcare insurance operations, enrollment, billing, financial reconciliation, or a related discipline preferred.
• Experience with Affordable Care Act Individual Marketplace business and reconciliation processes strongly preferred.
• Demonstrated ability to independently own complex operational responsibilities, establish priorities, make informed decisions, and drive results across matrixed teams.
• Strong knowledge of operational controls, regulatory compliance, audit readiness, issue management, and root-cause analysis.
• Experience performing quality assurance, control testing, operational assessments, or independent reviews and translating findings into actionable recommendations.
• Proficiency with Microsoft Excel, Word, PowerPoint, and Outlook. Experience with reporting, data visualization, or workflow automation tools is preferred.

Requirements

• 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.

Company Description

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.