Operations Support Director (Claim) - Evernorth - Remote

Position Summary

The Operational Support Director is responsible for leading and managing small to large cross-functional project implementation within Provider Operations, focusing on claim functions and initiatives. This role supports execution of the claim roadmap, refines project scope, and provides inputs on business cases in partnership with Operations, Capacity, Finance and Technology teams. The Director leads teams of operations experts and subject matter specialists, ensuring effective identification, prioritization, and implementation of new capabilities to auto adjudication, system enhancements, and automation opportunities, while providing oversight for existing operational capabilities required for success. Additionally, the Director is expected to drive continuous process improvement, foster a culture of innovation, and ensure alignment with organizational goals and regulatory requirements.

Key Responsibilities

• First Line of Defense for Production Support: Serve as the primary escalation point for production support needs, ensuring rapid response and resolution to system health issues impacting claim operations.
• Subject Matter Expert Management: Develop, manage, and mentor teams of subject matter experts to support initiatives across Provider Operations, ensuring expertise is leveraged for both project delivery and ongoing operational improvements.
• Stakeholder Communication & Collaboration: Proactively communicate and collaborate with a diverse range of stakeholders—including Operations, IT, Finance, and external partners—to align on priorities, share updates, and drive consensus on system enhancements and automation opportunities.
• Automation & System Enhancement: Define and lead the multi-year automation roadmap, prioritizing initiatives based on business needs and technical capacity, while identifying and mitigating risks and supporting change management efforts.
• Capability Oversight: Oversee Auto Adjudication, (AA) performance and enhancement efforts across all claim platforms, ensuring operational readiness and compliance.
• Governance & Controls: Partner and define requirements, develop automations, and own post-implementation controls and governance for sustained productivity, quality, and service gains.
• Compliance & Operational Oversight: Ensure compliant implementation and provide operational oversight for both frontend and back-office systems.
• Release Management: Lead system release cycles, including testing, validation, and control processes to maintain system integrity and support continuous improvement.

• Risk Management: Identify potential operational risks, implement mitigation strategies, and ensure contingency plans are in place to minimize disruptions.
• Budget Oversight: Identify opportunities for cost savings while maintaining high standards of service delivery.

Qualifications

• High School Diploma or GED required. Bachelor’s degree in Business, Operations Management, or a related field preferred.
• 8+ years progressive leadership experience within Medical Claims Operations with demonstrated success leading enterprise-wide initiatives, cross-functional teams, and large-scale operational change.
• Proven ability to operate at a director level, influencing senior and executive leaders and aligning diverse stakeholders to shared objectives.
• Deep experience in operational transformation, automation strategy, system modernization, and scaling innovation.
• Strong track record of delivering complex initiatives with measurable business impact in highly regulated environments.
• Demonstrated success working within highly matrixed organizations, partnering with operations, technology, finance, and risk leaders.

Leadership & Execution Skills

• Strategic thinker with the ability to translate vision into executable, results-driven plans.
• Exceptional stakeholder management, communication, and executive presence.
• Strong risk management mindset with the ability to operate effectively in ambiguous, fast-paced environments.
• Ability to manage multiple competing priorities while maintaining focus on enterprise outcomes.
• Excellent written, verbal, and active listening skills.

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.

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 144,200 - 240,400 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 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.