Role Summary

The Regulated Markets Services team is responsible for ensuring the execution of key operations accountabilities associated with all regulated lines of business including Medicare, Medicaid, and Marketplace (Exchange / Health Care Reform).  The team supports Pharmacy Benefit Management (PBM) delegated responsibilities associated with Call Center and Grievances oversight, regulatory audit support, issue management and analytics.

The Senior Analysts’ primary role will be to support the Grievance functions as it relates to the Medicare, Medicaid and Marketplace (Exchange / Healthcare Reform) initiatives to ensure member/client and internal satisfaction and alignment with both regulatory and client contractual support.  When necessary the analyst will also provide functional SME support to client facing discussions.

Responsibilities:

Provides highly proficient professional input to complex assignments/projects.Facilitates the intake, triage, root cause analysis, mitigation, impact analysis and closure of all client and audit issues associated with regulatory compliance of Grievances.Reviews, evaluates and executes on new regulatory guidance.Promotes the tracking and documentation of all team activities in associated systems.Supports the Product Teams, Operations Teams and Account Teams with function specific communications needs via account team/client inquiry requests, Field Alert development, deliverable reports and presentations.Build and distribute recurring and ad hoc reports for business partners and clients as assigned. Identify and integrate data from multiple data sources. Identify opportunities to automate manual data tasks and build process improvements.Maintain documented inventory of existing reports, routinely testing data validity and responding to inquiries regarding report details.  Create and maintain SOPs, job aids and reporting structure inventories.Participates as SME in client meetings regarding grievance processes.Coordinates or leads responses to Grievance RFPsCollaborates with Grievance and Call Center Operations teams to oversee the grievance process, identify and remediate trends and problems and develop and deploy creative solutions to improve efficiency, compliance and member satisfaction.Develops and deploys oversight and surveillance processes for Health Plan grievances.Acts as Business Owner for development and enhancement of grievance processes. Collaborates with Technical Product Owner to develop business requirements.Coordinate or lead portions of mid-size projects. Supports and provides direction to more junior professionals.Contributes to audit support processes for client program, data validation, oversight and operational audit needs, facilitate Client/Express Scripts preparation and support for audit scope and document completion of all audit deliverables and findings

Ideal Candidates will offer:

Bachelor’s Degree with a preferred focus of Health Care Administration or Business or equivalent experience1+ year experience in a health plan or PBM setting.  Medicare, Medicaid and Marketplace experience a plus.Able to balance high priority, long-term projects with short-term, immediate deadlinesCreative problem solving skillsAbility to follow processes and document information consistently and timely to meet obligationsAble to translate technical data concepts to business partners for understanding and alignmentProven ability to function in a heavily matrixed environment.Extensive knowledge of Microsoft Office products (particularly Excel, Word, and Power Point). Experience leading projects and working with cross functional teams, especially Business and Operations teamsAbility to work in a fast-paced deadline-driven environment, and juggle multiple, sometimes competing, priorities and requirementsHighly proficient process mapping and analysis skillsOpen communicator; excellent oral and written communication skillsAbility to motivate, influence and connect with othersAbility to influence direction and action; build and leverage internal relationships

* * * This is a hybrid role that requires the ability to work in office 3 days per week. * * *

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 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 61,600 - 102,600 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.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

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.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.