Complaint & Clinical Policy Advisor - MD - Hybrid

Complaint & Clinical Policy Advisor - MD Live - Hybrid page is loaded## Complaint & Clinical Policy Advisor - MD Live - Hybrid remote type:
Hybrid locations:
FL, Sunrise, 1571 Sawgrass Corporate Pkwy STE 140:
TN, Franklin, 730 Cool Springs Blvd STE 500:
IL, Chicago, 500 W. Madison St STE 3470:
NC, Raleigh, 701 Corporate Center Dr STE 200:
CT, Bloomfield, 900 Cottage Grove Rd Wilde Bldgtime type:
Full time posted on:
Posted Yesterday job requisition :
The Medical Complaint & Clinical Policy Advisor is responsible for the day-to-day operations and continuous improvement of MD Live’s medical complaint and clinical policy functions. This role owns the end-to-end medical complaint lifecycle—intake, investigation, service recovery, resolution, and trend analysis—ensuring timely, high-quality responses and sustainable corrective actions that enhance the patient and provider experience.

The Advisor also supports clinical policy governance across service lines, partnering with clinical, operational, and compliance stakeholders to develop, harmonize, and maintain evidence-based clinical policies. This role ensures data integrity, produces actionable insights, and drives policy education and adherence across the organization.
** What you’ll do to make a difference:
*** Own the end-to-end medical complaint lifecycle using a dedicated complaint management system.
* Receive, document, and track complaints from multiple intake channels (e.g., phone, email).
* Lead investigations, identify root causes, and resolve complex or sensitive cases with an elite service mindset and urgency to meet service level agreements.
* Support clinical service recovery activities, including customer outreach and refund processing.
* Analyze complaint trends to recommend process, product, or policy improvements.
* Provide clear, confident communication to customers and internal stakeholders throughout resolution.
* Support drafting, harmonizing, and updating clinical policies across service lines in partnership with clinical leaders.
* Align policy language, scope, and terminology across MD Live offerings.
* Coordinate structured review and approval processes with Clinical Leadership, Legal/Compliance, and the Policy Committee.
* Partner with operations, nursing, and medical directors to implement policy changes and monitor adherence.
* Maintain integrity of complaint and clinical policy data within C360 and other systems.
* Develop KPI dashboards, root-cause analyses, and leadership-ready reporting.
* Oversee compliance testing and evaluate effectiveness of corrective actions.
* Rebuild and maintain the clinical policy education pathway.
* Deliver hands-on training and communications related to policy updates and regulatory changes.
* Participate in special projects and perform other duties as assigned.
** What you’ll need to succeed:
*** Bachelor’s degree required.
* Project management or process improvement experience required.
* 2+ years of experience developing or supporting clinical policy in an ambulatory or inpatient setting.
* 5+ years of clinical or healthcare experience focused on improving patient satisfaction.
* Experience with C360 preferred.
* Strong analytical, investigative, and critical-thinking abilities.
* Demonstrated service recovery, conflict resolution, and de-escalation skills.
* Ability to manage multiple priorities in a fast-paced, dynamic environment.
* Experience with SAIGlobal (C360), Tableau, Microsoft Office (Word, Excel, PowerPoint), and commercial EMR systems.
* Professional, adaptable, and collaborative approach to achieving clinical, operational, and strategic objectives.##   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 10

Mbps download/5

Mbps upload.

For this position, we anticipate offering an annual salary of 95, 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…