问题解决负责人 分析师，个人牙科运营 - Cigna Healthcare

Position Summary
The Operations Lead Analyst is a key contributor within Stand-Alone Dental Operations responsible for researching and resolving complex, sensitive, and escalated customer issues received through multiple intake channels. This role manages assigned cases from intake through resolution, ensuring that work is completed accurately, timely, and in accordance with internal standards and applicable regulatory requirements.
The Operations Lead Analyst collaborates with Operations, Compliance, Customer Service, and business support partners to resolve federal and state-based marketplace inquiries, Department of Insurance matters, Senior Leadership escalations, and other complex customer concerns. The role also identifies trends, documents findings, recommends process improvements, and provides technical guidance to team members.
Core Accountabilities and Responsibilities
Customer Issue and Escalation Management

• Manage assigned customer issue intake queues by tracking, prioritizing, researching, documenting, resolving, and closing cases in accordance with established requirements.

• Research and resolve complex or sensitive customer issues, complaints, Senior Leadership inquiries, and Department of Insurance matters.

• Support customer inquiries received through federal exchange and state-based marketplace channels.

• Evaluate customer needs, determine appropriate next steps, and develop effective resolutions using sound judgment, technical knowledge, and established business processes.

• Communicate findings, decisions, and resolutions clearly and professionally to customers, business partners, and leadership.

• Maintain complete and accurate case documentation, including research performed, conclusions reached, actions taken, and final outcomes.

Regulatory Compliance and Case Controls

• Monitor case activity and turnaround times to ensure compliance with applicable regulatory and internal requirements.

• Identify and escalate potential compliance risks, missed dependencies, or barriers that could affect timely and accurate case resolution.

• Apply current marketplace, dental-product, and customer-issue resolution requirements when researching and resolving assigned matters.

• Protect customer information and follow applicable privacy, security, documentation, and records-management requirements.

• Support requests for case information, documentation, or subject matter expertise related to audits, compliance reviews, and operational inquiries.

Analysis and Process Improvement

• Analyze customer issues and case activity to identify recurring themes, operational trends, process gaps, and emerging risks.

• Document findings and recommend practical improvements to customer service processes, workflows, controls, communications, or supporting documentation.

• Participate in operational projects, business testing, and process-improvement initiatives supporting Stand-Alone Dental Operations.

• Provide frontline observations and subject matter expertise to help improve customer experience and operational effectiveness.

• Support the validation of process changes and confirm that implemented solutions address the identified business need.

Team and Cross-Functional Support

• Serve as a technical resource for team members by answering questions, sharing knowledge, and providing guidance on complex cases and established processes.

• Partner with Operations, Compliance, Customer Service, and business support teams to research issues and coordinate timely resolutions.

• Build and maintain effective working relationships with matrix partners across the organization.

• Share relevant trends, risks, and lessons learned to strengthen team knowledge and improve consistency.

• Independently manage assigned workload, competing priorities, and time-sensitive requests in a fast-paced operational environment.

Qualifications
Required

• Minimum of three years of healthcare insurance business experience in areas such as benefits, eligibility, claims, customer service, contact center operations, sales, or business operations.

• Minimum of two years of experience handling complex Stand-Alone Dental customer inquiries.

• Current experience within IFP, including marketplace operations, regulatory requirements, and customer issue resolution processes.

• Demonstrated understanding of federal exchange and state-based marketplace environments.

• Strong knowledge of customer issue research, case management, escalation handling, and documentation requirements.

• Ability to manage multiple priorities, meet tight deadlines, and adjust quickly to changing business needs.

• Strong analytical, decision-making, and problem-solving skills.

• Ability to apply technical knowledge, business processes, and available resources to drive accurate and timely resolution.

• Strong verbal and written communication skills, including the ability to document complex findings clearly and professionally.

• Proficiency with Microsoft Office applications and internal systems used to support IFP and Dental operations.

• Ability to work additional hours and adjust planned time off during peak operating periods, based on business needs and applicable company practices.

Preferred

• Experience handling Senior Leadership escalations, Health Insurance Casework System matters, or Department of Insurance casework.

• Experience with IFP Dental products, systems, and processes, including Dentacom, Dentaque, OneView, and applicable claim-processing guidelines.

• Experience supporting operational testing, trend analysis, process improvement, or business documentation.

• Experience providing technical guidance, peer support, or informal leadership within an operational team.

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 62,600 - 104,300 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 Cigna Healthcare
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.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 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.
Originally posted on Himalayas