- Provides day-to-day oversight assigned issue resolution activities as IRL
- Validates assignment of responsible SMEs
- Coordinates identification of root cause and impact analysis
- Drives assessment and selection of short/long-term mitigation
- Coordinates CAP resolution with Compliance and/or Account Team as needed
- Coordinates audit finding remediation activity w/audit process
- Supports Account Team issue discussions w/client
- Escalates past due / high risk issue resolution
- Ensures timely documentation of issue outcomes using team tools and processes
- Manage an active pipeline of issues and participate in continuous process improvement activities
- Regulated Markets specific knowledge required, Medicare, Medicaid and/or Marketplace
- Skilled in managing issue intake pipeline and triage
- Self-starter and able to set direction individually and among a team
- Proficient in identifying dependencies and prioritizing focus
- Ability to connect, network and build strong relationships in order to influence and drive work in a matrix environment.
- Understanding of Agile and other project methodologies
- Two or more years' experience in a PBM or managed care environment; preferably in Regulated Markets.
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Lead Analyst - St Louis, United States - The Cigna Group
Description
Summary
Partners with the Senior Manager to establish strategies to manage issue management pipeline impacting Regulated Markets. Interfaces with multiple departments (e.g., Product, Account Team, Compliance, etc.) to develop relationships to resolve issues involving regulatory risk/impact. May lead projects or project steps within a broader project or have accountability for ongoing activities or objectives. Exercises organizational, planning, communication and analytical skills. Uses professional knowledge and acumen to advise functional leaders. Focuses on providing thoughtful leadership within Product Management but works on broader projects, which require understanding of wider business. Recognized internally as an Issue Resolution Lead (IRL) to facilitate the Regulated Markets' Issue Management process.
Role Summary
The Regulated Markets Issue Management Lead Analyst role is responsible for facilitating the timely resolution of issues impacting regulatory compliance, client/regulator CAPs and audit findings remediation for the Regulated Markets book of business. This individual serves as the point of contact for functional SMEs and other functions supporting assigned issues. Collaborates with Product Management SMEs, Compliance, Legal and other stakeholders to respond to State, Center for Medicare and Medicaid Services (CMS) and Client audit findings and CAPs. May represent Express Scripts in discussions related to issue resolution. Ensures documentation and data entry aligned with function processes. Drives timely resolution of findings and/or deliverables.
Essential Functions
Knowledge/Skills and Abilities:
**_* This is a hybrid role that requires the ability to work in person. *_**
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 require reasonable accommodation in completing the online application process, please email: for support. Do not email 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.
