POSITION SUMMARYProvides advanced professional input to complex Operations Management assignments/projects. Supports and provides direction to more junior professionals. Works autonomously, only requiring "expert" level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Business Operations. May lead projects or project steps within a broader project or have accountability for ongoing activities or objectives.
Primary Responsibilities- Lead and manage the resolution of often complex issues involving multiple clients and customers that are reported to the Pharmacy Reliability team, escalating as appropriate for high risk or ongoing issues.
- Triage, research and resolve single member issues that require escalation support from business partners (i.e. Call Center)
- Use Pharmacy benefit design knowledge to assess and evaluate impact and implications for complex and/or multiple client issues from a cost, contractual and legal standpoint.
- Summarize, articulate, and explain the issue, impact reporting as well as identifying appropriate stakeholders and communicating results as needed.
- Partner with Customer Service, Claims Department, Client Implementation & Service, and PBM vendors to ensure reimbursement is completed timely and accurately for individual members and clients.
- Act with urgency to identify barriers and escalate as appropriate to drive engagement of proper business units and stakeholders to bring complex issues to resolution.
- Use best practices and knowledge to improve processes, products, and services
- Assist in identification of root cause and determination of future preventive measures for all assigned Client Service Issues.
- Develop strong partnerships with cross-enterprise partners in Pharmacy Operations, coordinating efforts to achieve goals, leveraging best practices.
- Calculate impact to clients, customers, and/or pharmacies using both internal and external claims reports
- Submit documents communicating impact to appropriate matrix partners to facilitate financial remediation
- Maintain and regularly update issue tracking ticket in SharePoint
- Manage and coordinate funding of remediation (DMR's, P&L, E&O, etc.)
- Provide executive level communications for escalated issues.
- Analyze issues of increased complexity inquiries and determines appropriate technical area or vendor to solve problems.
Key Qualifications- High School Degree or GED required. Bachelor's degree preferred
- 3+ years' relevant experience in a Pharmacy Benefit Management (PBM) related role required- i.e., Operations, Quality, Implementation or Reporting Analytics
- Working knowledge of internal Cigna systems: (i.e. ePro, BPL, CIT, etc. are preferred)
- Expert level understanding of Pharmacy operations
- Financial acumen/claim processing knowledge required
- Must be able to exhibit strong analytical skills to assess/understand financial impacts
- Must have strong decision making skills
- Must be able to facilitate issue/impact analysis discussions; making the complex simple to understand
- Proven experience in analytical thinking utilizing proficient technical skills with MS Excel (formulas, pivots, etc.)
- Strong critical thinking, resolving and negotiating skills.
- Experience applying logical problem solving methodologies (i.e. Six Sigma, Total Quality, etc.) to solve issues and identify root cause and improvement opportunities.
- Ability to navigate ambiguous scenarios which involve multiple organizational areas and bring those areas together for problem solving and process discussions.
- Demonstrated issue management/organizational skills; ability to plan for both the long and short term.
- Detail oriented, with proven ability to prioritize multiple tasks and adjust work to meet service standards.
- Must be able to work independently, with little supervision
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 62,600 - 104,300 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 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
