ACA Risk Adjustment EDGE Administrator - Cigna Healthcare - Remote at The Cigna Group

United States

$96.4k - $160.6k

Job Description The ACA Risk Adjustment EDGE Administrator plays a critical role in ensuring compliant, efficient, and high‑quality operation of Cigna’s EDGE server environment supporting ACA Risk Adjustment. This position is ideal for a proactive, detail‑oriented professional with strong technical acumen and a passion for healthcare data. The EDGE Administrator will oversee daily operations, manage data submissions, monitor processing outcomes, and collaborate across business and technical teams to maintain compliance with CMS regulations in a fast‑paced, evolving environment. Responsibilities: Manage day‑to‑day operations of the CMS EDGE server, including file ingestion, error resolution, and submission monitoring Coordinate execution of baseline, incremental, and command‑driven processes for Cigna’s AWS‑hosted EDGE environment Monitor release updates, reference data changes, and deployment timelines to keep the system in sync with CMS schedules Oversee troubleshooting and remediation of file processing, configuration, and validation errors within the EDGE environment Interpret CMS technical guidance, ICD updates, O&MM manual changes, and regulatory communications to ensure aligned EDGE operations Conduct quality checks, reconcile enrollment and claims data, and support risk score accuracy and regulatory compliance Collaborate with IT security and infrastructure teams to monitor and maintain EDGE instances in accordance with CMS requirements and Cigna policies Maintain documentation of procedures, system configurations, data flows, and operational controls Collaborate with teams to maintain and optimize data pipelines using AWS, Databricks, Python, SAS, and Oracle to support EDGE submissions and related analytics Core Competencies: Strategic Thinking: Anticipates operational impacts of CMS changes and EDGE updates; plans proactively to maintain compliance and performance Project Management: Manages timelines, dependencies, and deliverables for submissions, deployments, and remediation activities. Analytical Expertise: Leverages analytical tools to diagnose issues, validate data, and improve system accuracy Stakeholder Management: Communicates clearly and effectively with technical teams, business partners, and external stakeholders to drive alignment Adaptability: Adjusts quickly to evolving CMS regulations, new EDGE releases, and shifting marketplace operational needs Collaboration: Works across cross‑functional teams to deliver high‑quality outputs and coordinated execution Qualifications / Experience: Bachelor’s degree in Information Systems, Computer Science, Data Analytics, Public Health, or related field (or equivalent experience) 3+ years of experience in ACA Risk Adjustment and EDGE operations Deep understanding of ACA Marketplace operations, Risk Adjustment methodology, and CMS EDGE submission requirements Familiarity with CMS communication channels (e.g., REGTAP, FM Community) and published guidance (e.g., O&MM manuals, ICD, EDGE Server Business Rules) Hands‑on experience with AWS services relevant to EDGE workflows (e.g., Infrastructure as Code, Terraform) Proficient in using Databricks to create unity catalogs, pipelines, Proficiency in SQL and SAS to query, analyze, and manage large healthcare datasets (i.e., preparing ETL and ELT scripts) Proficiency in Tableau to present insights through reports and dashboards Fluent in data warehousing, data modeling, and business intelligence concepts and tools Demonstrated track record of troubleshooting large healthcare data files and EDGE validation errors Excellent problem‑solving skills with the ability to perform root cause analysis and recommend sustainable solutions Familiarity with healthcare regulations (e.g., HIPAA) 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 96,400 - 160,600 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 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 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.