4 days old

Medicare Part D Risk Operations Lead Analyst- Work from Home

Phoenix, AZ 85003
  • Job Code
Role Summary:

This role monitors risks and issues within the Medicare Part D Pharmacy Operations area and assists business owners with effective remediation by logging issue details, keeping track of action plan timeliness, monitoring progress, identifying obstacles, and facilitating cross-functional communications. Working with Compliance partners, this role will ensure remediation is aligned to regulatory requirements. Role will also work closely with EGWP teams and market-specific issue management. Role also serves as a process improvement partner with business owners and is expected to drive change where needed to reduce risk and recurrence of issues.

Core Responsibilities:

  • Monitors self-reported items, prepares and maintains risk and issue action plans in reporting tool(s) to ensure complete, accurate and timely information is available to all stakeholders; establishes a cadence of regular update cycles for communication with business partners with clear expectations and timelines on next steps as well as regular updates with Compliance. This may also include formal Medicare Compliance Action Plan support.
  • Supports our EGWP and MAPD account teams to identify market-specific risks and issues and works with Pharmacy Operations leaders toward effective root cause identification and remediation; leads and facilitates regular issue tracking meetings with each account team; works cross-functionally with commercial teams, as needed, to identify, track and collaborate on risks and issues that have impact across product lines.
  • Reconciles issues from multiple work streams to ensure all issues have Compliance visibility and works to ensure non-duplication of issues.
  • Monitors and tracks industry and vendor communications for risk potential, ensuring visibility to impacted business owners and Compliance.
  • Cross-examines and validates root cause on action plans by seeking to understand operational processes and impacts to ensure effective remediation efforts and other potential upstream or downstream impacts; makes recommendations to business owners on process improvements.
  • Assists with projects as directed by Pharmacy Operations management.
  • Develops SOPs, process flows, tools, job aids or other items, as needed, to support risk management processes along with assisting business teams with those items.
  • Ensures an ability to meet production demands and maintain a high level of quality.This may include occasional overtime, especially during the peak seasons.

Minimum Qualifications:

  • Minimum 5 years of pharmacy claims or Prescription Benefit Management experience.
  • Minimum 2 years of Account or Relationship Management experience.
  • A solid understanding of Corrective Action Planning processes and remediation efforts
  • Familiarity with CMS guidance and regulations.
  • Ability to plan, coordinate and drive action plan deliverables
  • Ability to document clear and concise business updates and Compliance requirements
  • Ability to analyze business process and identify risks
  • Exceptional verbal and written communication skills
  • Ability to work independently as a detail- and results-oriented self-starter who is a team player with an ability to achieve build and manage business relationships
  • Strong working knowledge of Microsoft Excel, Word, Visio, Outlook and SharePoint
  • Process engineering experience preferred
  • CPhT preferred
  • SharePoint development experience preferred
  • Familiarity with Medicare CPE reporting preferred

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: 2021-06-09 Expires: 2021-07-08
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Medicare Part D Risk Operations Lead Analyst- Work from Home

Phoenix, AZ 85003

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