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

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)

ACA Risk Adjustment EDGE Administrator

Key skills