ACA Risk Adjustment EDGE Administrator
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
ACA Risk Adjustment EDGE Administrator managing the CMS EDGE server operations at Cigna Healthcare. Overseeing data submissions, compliance, troubleshooting, and collaboration across teams.
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
Requirements:
- 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
- Excellent problem‑solving skills with the ability to perform root cause analysis and recommend sustainable solutions
- Familiarity with healthcare regulations (e.g., HIPAA)
Benefits:
- health-related benefits including medical, vision, dental
- well-being and behavioral health programs
- 401(k)
- company paid life insurance
- tuition reimbursement
- minimum of 18 days of paid time off per year
- paid holidays
Similar Jobs
Director of Portfolio Construction and Risk Management
Director of Portfolio Construction & Risk Management at Wealth Enhancement overseeing portfolio frameworks and analytics. Enhancing investment processes and collaborating across teams for optimal outcomes.
Governance & Control Analyst II
Governance & Control Analyst providing analytical support for governance and control processes in the financial sector. Engaging in research, evaluation, and reporting tasks to enhance business performance.
ICAM Engineer – Identity Governance
ICAM Engineer - Identity Governance developing enterprise-scale Identity solutions for DoD. Designing, integrating, and maintaining identity governance systems in secure environments.
Sport Risk Manager
Sport Risk Manager handling betting operations for SOFTSWISS Sportsbook. Engaging in risk control, odds management, and performance optimisation across multiple sports and leagues.
Communications Governance Administrator
Communications Governance Administrator responsible for compliance in mortgage servicing communications. Drafting customer-facing materials and collaborating with business leaders and legal counsel.
Senior Data Architect – Data Governance, Architecture
Senior Data Architect focused on data governance and architecture in remote strategic projects. Ensuring data architecture scalability, governance, and innovation at Avantti Tecnologia.
Director, Enterprise Transformation – Governance
Director leading enterprise transformation & governance initiatives for D-Wave, a quantum computing leader. Overseeing modernization and analytics-driven operational scaling initiatives with executive collaboration.
Group Risk Specialist – Governance and Control
Group Risk Specialist providing risk management expertise to support the 1B team at TD. Collaborating across priorities for risk assessments, governance routines, and regulatory change management.
Data Governance Student Worker
Student Worker in data governance supporting projects and programs at OHSU. Providing general administrative support for the Data Governance Program and Office.
Head of Risk
Head of Risk responsible for establishing and maintaining risk management framework in El Salvador. Collaborating with senior leadership to mitigate risks in fintech environment.
Senior Business Analytics Manager – Trend Analytics, Risk Ecosystem
Senior Manager leading analytics to design clinical and affordability insights for Cigna Healthcare. Collaborating across teams to deliver trend analysis and improve decision-making.
Risk Control Consultant
Risk Control Consultant providing evaluations and consultative services in a remote setting. Working with global teams and developing risk control strategies for complex accounts.
Insider Risk Analyst – SkillBridge Intern
Insider Risk Analyst - SkillBridge Intern at Zscaler focusing on behavioral analysis and data protection. Part of Enterprise Security team defending Zscaler's infrastructure and data.
Data Governance Risk Analyst
Data Governance Risk Analyst improving data management and risk governance at Banner Bank. Collaborate cross-functionally to ensure data is trusted and aligned to enterprise risk standards.
Senior Manager, Controls & Governance
Senior Manager of Controls & Governance leading operational controls and frameworks for fiber construction at Zayo. Manage performance, reporting, and decision-making in complex projects.
Data Quality and Governance Analyst 2
Data Quality and Governance Analyst building a data governance program for a major consumer goods client. Establishing frameworks and standards to transform real estate data for business decisions.
Pricing & Risk Director
Lead Kin’s Pricing & Risk Management department focused on pricing strategy and risk frameworks. Collaborate with executives to align decisions with market realities and regulatory expectations.
Risk Manager I
Risk Manager I managing risk segmentation strategies for TD Bank, providing detailed analyses and implementing risk management policies. Collaborating with cross-functional teams to enhance credit assessment capabilities.
Risk Analyst
Risk Analyst role at Patriot Software, focused on fraud protection through thorough application and identity checks. Collaborating with teams to ensure compliance and develop secure software features.
Senior Governance & Control Specialist – Logical Access
Senior Governance & Control Specialist leading governance and control functions for TD Bank. Providing expert guidance and strategic direction to executive and functional stakeholders.