Protect compliance and data integrity by monitoring Medicaid Encounter processes and identifying risks that could impact state and client submissions. Analyze file data, trends, and metrics to uncover issues, recommend solutions, and improve submission accuracy and timeliness. Drive continuous improvement by documenting processes, evaluating performance, and recommending practical enhancements aligned to state guidance. Lead and support encounter reject analysis and remediation efforts to meet regulatory requirements and client expectations. Serve as a subject matter expert for internal and external partners, translating complex information into clear, actionable insights. Partner across teams to support cross-functional initiatives and ensure shared accountability for outcomes. Communicate status, risks, and recommendations during client, account team, and state discussions with confidence and clarity. Support performance guarantees by tracking outcomes, sharing insights with leadership, and helping teams stay aligned on goals. Qualifications. Required. Minimum of 5 years of professional experience in business analysis, operations, product support, or a related role. Proven experience analyzing large data sets and translating metrics into trends, insights, and improvement actions. Strong problem-solving skills with the ability to operate effectively in complex and regulated environments. Experience partnering with internal teams and engaging directly with clients or account teams. Proficiency in Microsoft Excel and comfort working across multiple systems to extract and analyze data. Preferred. Bachelor’s degree in business, healthcare, analytics, or a related field .–7 years of experience within a PBM or healthcare environment. Knowledge of State and Federal Medicaid regulations and Encounter submission requirements. Experience with Tableau reporting, SQL, or data visualization tools. Strong written and verbal communication skills, including leading discussions and composing client-facing materials. 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 10 Mbps download/5 Mbps upload. For this position, we anticipate offering an annual salary of 113,200 - 188,600 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 and paid holidays. 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.