22 days old

Business Operations-Operations Management-Operations Senior Analyst- Work From Home Opportunity

Memphis, TN 38103
  • Job Code
Job Summary:
  • Significant depth or breadth of knowledge within Pharmacy Operations.
  • Delivers specific delegated complex technical, administrative, or operative tasks assigned by manager.
  • Analyzes and verifies internal consistency, completeness, and accuracy of operational documents for submission; makes adjustments.
  • Contributes to the production levels and effective processing controls and related reporting in accordance with established procedures.
  • Ensures that production levels and targets are achieved and effective processing controls are in place.
  • Tasks involve a significant degree of forward planning and anticipation of needs/issues.
  • Resolves non-routine issues escalated from more junior team members.
  • Completes day-to-day tasks autonomously, but has ready access to advice from more experienced team members.
  • Develops and maintains resources for an assigned group.
  • Provides proactive guidance, coaching, and direction to more junior team members of the team.

Core Responsibilities:

Responsible for Member Issue Resolution (Grievances/CTMs/etc)

  • Analyze Member complaints to determine root cause and resolution path
  • Oversee Member complaints/inquiries escalated internally for resolution, including analysis and approval of root cause, response and resolution
  • Oversee Member complaints/inquiries escalated to PBM for resolution, including analysis and approval of PBM root cause, response and resolution.
  • Comply with Internal and CMS requirements for resolution of complaints/inquiries
  • Communicate Member complaints/inquiries to impacted stakeholders (Internal and External)
  • Resolve non-routine issues escalated from more junior team members
  • Maintain accurate and complete metrics of Member complaints received including volume, type, and timing.

Responsible for oversight of one or more Medicare Part D Business Processes

  • Drug Recall Notification process
  • Third Party Direct Claim Submissions
  • Emergency Access to Benefits
  • Review and approval of Procedures and Job Aids for above assigned Business Processes

Supports Manager with strategic priorities and Audit/Regulatory assignments, as needed

Minimum Qualifications

  • Excellent and proven communication skills - able to clearly convey complex blends of business and technical matters to a range of audiences; able to articulate points clearly and concisely; able to negotiate effectively with diverse stakeholders.
  • 5+ years of collective experience working within a Medicare Part D benefit, customer service, claim or appeal/prior authorization role.
  • Thorough knowledge of Medicare Part D CMS requirements and claim adjudication protocols
  • Ability to conduct analysis of complex data
  • Ability to work independently
  • Willingness to take on new roles and challenges
  • Proven functional skills in management of competing and changing priorities
  • Proven ability to work effectively within cross-functional teams, and business/information technology stakeholders
  • Experience in pharmacy claim analysis and claim resolution
  • Bachelor's degree or equivalent experience preferred
  • Recognized current or previous professional Pharmacy Certification preferred

This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

Posted: 2021-11-12 Expires: 2021-12-11
Sponsored by:
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Business Operations-Operations Management-Operations Senior Analyst- Work From Home Opportunity

Memphis, TN 38103

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