Operations Lead Analyst - Express Scripts - Remote

Summary:

The CDH Triage team is a part of the larger CDH Services organization which serves at the hub of the integrated accumulator ecosystem between Express Scripts, Cigna, our Health Plan clients and third party medical benefit providers. It is a fast paced, high volume work environment with around 10K requests worked annually; requests vary in type and complexity from administrative to issue management. To be successful in this role, you must be able to build and maintain working relationships with both internal and external partners, both operational and technical.

Key Responsibilities:

• Build and maintain the Express Scripts (ESI) relationship with third party medical providers and health plan clients for which ESI shares accumulators with for claims processing

• Accountable for day to day issues and inquiries, technology and connectivity, performance, and trending analytics

• Meet regularly with vendor team to understand non data trends and day to day tactical business needs

• Navigate the complex and varied interactions with vendors and internal partners

• Make recommendations to leadership for process improvements, systems upgrades, or technology changes

Job Requirements:

• Understanding of Consumer Driven Health (CDH) product (preferred but not required)

• Working knowledge of upstream functional processes (preferred but not required) such as:
• Accumulator Benefits and Modular Frames

• Eligibility

• Claims Processing

• Ability to use data to identify opportunities and drive positive outcomes

• Must have strong communication skills and understand the dynamics of complex relationships between medical providers, account teams and internal functional/IT resources

• Ability to work cross-functionally, managing multiple requests/issues with competing deadlines

• Demonstrate agility and an ability to adapt to an ever-changing governmental regulatory landscape

• Ability to work independently and as part of a team, self-driven and requiring minimal oversight

• Must be a quick learner and a team player

• Ability to learn the entire end-to-end process

• Logical reasoning and attention to detail

• Strong problem-solving and critical thinking skills

Qualifications:

• High School diploma or GED required

• 3+ years of experience in healthcare setting preferred (operations or significant cross-functional experience) required

• Experience with Microsoft Office software preferred

• Demonstrated analytical, strategic planning, communication and problem solving skills preferred

• Demonstrated initiative, independent thinker and worker preferred

• Ability to work both independently with moderate guidance and ability to work seamlessly within a larger team preferred

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.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 need a reasonable accommodation to complete the online application process, please email for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.

Originally posted on Himalayas