Continuous Improvement Sr. Advisor- Prior Authorization

About the position The Senior Continuous Improvement / Business Process Engineer plays a key role in improving how healthcare call center and claims operations work. In this role, you’ll lead complex, cross‑functional initiatives, take on ambiguous, enterprise‑wide challenges, and deliver meaningful, measurable improvements through smarter processes, data‑driven insights, and automation. This is a senior, hands-on individual contributor role with full ownership from idea to impact—it’s not an advisory position. You’ll be trusted to set priorities, make decisions, and drive execution, partnering with teams across the organization and influencing outcomes without formal authority. Responsibilities • Process Improvement & Operational Excellence Identify and frame high value improvement opportunities, defining problems to solve based on business value, risk, and scalability—not solely assigned initiatives • Lead end to end improvement initiatives across functions and teams, from problem definition through implementation, adoption, and sustainability • Navigate high complexity environments with competing priorities, unclear requirements, and multiple stakeholders • Quantify, validate, and track benefits including cost savings, capacity creation, quality improvement, and risk reduction, ensuring value realization is achieved and sustained • Serve as a change leader, addressing resistance, aligning stakeholders, and ensuring improvements stick beyond implementation Business Process Engineering & Documentation • Lead enterprise level current state and future state process design, spanning multiple functions, handoffs, and systems • Facilitate complex working sessions to uncover root causes, systemic constraints, and interdependencies • Redesign and standardize processes to improve clarity, consistency, scalability, and operational readiness • Translate complex workflows into clear, consumable artifacts tailored for frontline teams, operational leaders, and executives • Establish and evolve process standards in partnership with business and technology leaders Automation, AI & Technology Enablement • Proactively integrate automation, AI, and product thinking into improvement solutions rather than treating automation as a downstream add on • Evaluate operational feasibility, change impact, and scalability of proposed solutions • Partner with technology, product, and automation teams to shape solutions that balance speed, risk, and long term sustainability • Contribute to business cases by clearly articulating expected benefits, tradeoffs, and implementation considerations • Support requirements definition, testing strategy, and implementation readiness as needed Data Analysis, Measurement & Insight Generation • Use data to identify opportunities, validate hypotheses, and inform prioritization decisions • Define success metrics upfront and own ongoing benefit validation and reporting • Translate complex data into clear, actionable recommendations for senior operational leaders • Ensure measurement approaches support enterprise level decision making, not just project reporting Stakeholder Partnership, Influence & Leadership • Serve as a trusted improvement partner to directors, VPs, frontline leaders, technology partners, and external vendors • Make and own strategic and tactical decisions within initiatives, escalating only when appropriate • Influence outcomes through credibility, judgment, and strategic framing, not positional authority • Coordinate multiple initiatives and teams simultaneously, aligning work to enterprise priorities • Mentor and coach junior CI/BPE practitioners, raising overall CI maturity and capability across the organization Requirements • Minimum of 8 years experience in continuous improvement, process engineering or operational excellence • High School Diploma required, Bachelors Degree preferred • Proven ability to own and lead ambiguous, cross‑functional initiatives to measurable outcomes • Advanced application of Lean and/or Six Sigma methodologies, including adapting approaches to fit business context • Strong end‑to‑end process mapping, redesign, and documentation skills • Data‑driven decision‑maker with experience defining and validating benefits (Excel required; BI/SQL a plus) • Demonstrated ability to influence senior stakeholders without formal authority Nice-to-haves • Healthcare, pharmacy, claims processing, or call center operations experience • Prior authorization or utilization management exposure • Experience integrating or supporting automation, workflow tools, RPA, or AI solutions • Familiarity with generative AI or emerging automation technologies • Proficiency with Visio, SharePoint, Confluence, or similar documentation platforms • 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. Benefits • 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.