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West Bloomfield Township

    Operations Lead Analyst - Bloomfield, United States - The Cigna Group

    The Cigna Group
    The Cigna Group Bloomfield, United States

    2 weeks ago

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    OTHER
    Description
    The job profile for this position is Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

    Excited to grow your career?

    We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

    Our people make all the difference in our success.

    Primary Responsibilities:

    Responsibilities include leading external audit vendors, brokers and clients to understand audit rights and processes from start to finish. Lead negotiations of audit scopes for various audit types including Benefit Implementation Audits (BIA), Financial Audits (FA), and internal audits. Ensure proper legal documents are fully executed prior to releasing any claim data to external parties. Adhere to specific audit rights outlined within individual Administrative Service Only (ASO) agreements. Work closely with internal partners to ensure accurate data is ordered, validated and provided to external audit firms. Develop and maintain strong working relationships with internal and external partners. Educate business partners on the appropriate audit process and our client's legal rights to perform audits. Partner with external audit firms, clients, and brokers to ensure audit is successfully completed. Engage and drive improvement opportunities and remediation work with internal teams based on audit results.

    Required and preferred skills:

    • 3+ years managed healthcare experience
    • Demonstrates knowledge of Cigna HealthCare's lines of business and related systems, such as ProClaim, PowerMHS, Facets, Dentacom and Diamond highly preferred.
    • Strong technical background in various claim platforms, primarily Proclaim, to support detailed claim research.
    • Technical knowledge of Call Operations or Call Quality programs and processes preferred
    • Demonstrates strong project management skills leading internal partners through the External Client Audit process
    • Exceptional verbal and written communication skills with demonstrated ability to research, problem solve, trouble shoot, influence and partner across the organization.
    • Takes personal accountability for contributions to team and organizational results
    • Experience with Healthcare Claims data and knowledge of end to end claims operations management strongly preferred.
    • Works effectively with larger groups from a wide range of organizations, as well as reporting out to senior leaders and clients
    • Demonstrated ability to collaborate and ability to develop and maintain effective relationships with individuals at various levels.
    • Strong Business Acumen required
    • Ability to multi-task and manage multiple projects simultaneously
    • Ability to keep matrix partners and business owners on task and meet external deadlines
    • Ability to work independently
    • Ability to work successful in a team environment
    • Ability to problem solve - Ability to think critically with respect to efficiency improvement
    • Proficient in Microsoft Office Suite, specifically Excel, Word and PowerPoint
    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, ,000 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.

    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.

    Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

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