Role Summary

The Provider Data Lead Representative is responsible for the accurate maintenance, correction, and integrity of provider data to support overall network quality. This role ensures that provider information is properly managed across core systems, including HCPM, CPF, and Facets, through timely updates, corrections, and terminations.

The position is also accountable for resolving claim, demographic, and contract-related fallout to prevent recurrence, enhance data accuracy, and improve the overall customer and provider experience.

Key Responsibilities

• Execute provider data additions, terminations, and updates in accordance with established procedures and business needs.
• Perform data remediation activities within HCPM, CPF, and Facets to maintain system accuracy and consistency.
• Implement updates identified through quality audits and performance analyses to improve data integrity.
• Apply contract terms and network business rules to ensure accurate and compliant data outcomes.
• Identify operational risks and issues encountered during data load processes and take appropriate corrective action.
• Validate data accuracy across multiple systems and ensure successful transmission to downstream platforms.
• Conduct root cause analysis to diagnose issues and implement solutions aligned with desired outcomes.
• Analyze intake requests from matrix partners to assess impact and execute appropriate provider, network, or criteria-level updates across systems.
• Adhere to established production and quality standards, including accurate and timely documentation in the Daily Activity Log (DAL).
• Support system enhancement initiatives by participating in testing, validation, and checkout activities as directed.
• Collaborate effectively within a team environment while maintaining accountability for individual contributions and results.

​Qualifications

• High school diploma or GED required; some college coursework preferred.
• 2+ years of demonstrated proficiency using CPF and HCPM required (Proclaim and Facets preferred).
• Strong understanding of data flow and downstream system impacts.
• Knowledge of provider structures, including Practitioners, Groups, Facilities, and Ancillaries required.
• Solid understanding of contracts, networks, and applicable Market Guidebook standards is highly preferred.
• Working knowledge of tools such as DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, and Knowledge Exchange is highly preferred.

Competencies

Adaptability & Learning Agility

• Navigating Ambiguity – Demonstrates the ability to operate effectively in uncertain or evolving environments, exercising sound judgment and decision-making.
• Continuous Learning – Rapidly acquires, processes, and applies new information to meet changing business demands.

Problem Solving & Critical Thinking

• Analytical Problem Solving – Evaluates complex issues, identifies root causes, and implements practical, results-oriented solutions.
• Systems Thinking – Leverages organizational tools, processes, and systems to drive consistency, efficiency, and scalable outcomes.

Communication & Collaboration

• Effective Communication – Conveys information clearly and professionally, while actively listening to ensure alignment and shared understanding across stakeholders.

Execution & Productivity

• Time and Priority Management – Effectively organizes workload, prioritizes competing demands, and consistently meets deadlines.
• Resilience and Persistence – Maintains focus and determination in the face of challenges, driving tasks through to successful completion.

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 The Cigna Group

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.

High school diploma or GED required; 2+ years demonstrated proficiency with CPF and HCPM required; knowledge of provider structures required; strong understanding of data flow and downstream impacts; remote work requires high-speed internet.

Key Responsibilities

• managing provider data
• performing data remediation
• resolving data issues

Skills & Tools

HCPM, CPF, Facets, Proclaim, DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, Knowledge Exchange

Job Details

• Category: Business Operations
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — United States
• Salary: USD 49,920 – 74,880 / year
• Languages: English

Benefits

• Generous paid time off
• Tuition reimbursement
• Retirement plan

About The Cigna Group

A global health service company dedicated to improving the health and vitality of those we serve. — Industry: Healthcare