Network Operations Lead Analyst, Retail Compliance- Express Scripts

POSITION SUMMARY

The Network Operations Lead Analyst will assist internal and external business partners in all aspects of Pharmacy operations including: Credentialing, re-credentialing, provider compliance, provider contracting, network support, validations and day to day pharmacy inquiries. The Lead Analyst will provide support, strategic direction, and operational oversight, including process improvement, automation, new technology solutions, audit support, adherence to internal process and procedures, and compliance with new and existing regulations.  

ESSENTIAL FUNCTIONS

• Works closely with our Independent providers assisting with day to day operations, including but not limited to: application and credentialing support, provider communication, Network participation, Network rejects, claims research, and triage.

• Participate in internal and cross functional meetings, assisting with development, design, and testing of our new business applications. 

• Assist with team development, training, and reviewing SOP’s/P&P’s to ensure processes are accurately documented and followed through day to day business interactions. 

• Identify and align business process efficiencies between our teams and cross functional partners

• Focus on process improvement, automation, technology, and cross-functional partnerships to drive change and deliver operational excellence.

• Ensures network providers adhere to and maintains compliance with state and federal regulations.

• Provides support to client and internal audit functions.

• Lead internal and cross functional projects

• Ability to research complex issues while also ensuring timely resolution.

QUALIFICATIONS

• Bachelor’s Degree preferred, HS Diploma required

• At least 3 years related Pharmacy benefit management experience preferred, including familiarity with the regulatory environment and compliance issues (i.e., URAC accreditation maintenance, credentialing, delegation and oversight standards, etc.)

• Strong analytical, planning, problem identification and resolution skills required

• Ability to work in a fast-paced environment and multi-task across multiple deadlines and deliverables, often under uncertain or ambiguous circumstances

• Excellent communication, organizational, and time management skills essential

• Comfortable communicating concerns, questions, and risk at all levels of the organization

• Consistently maintain a positive, helpful, engaged attitude

• Self-starter that can independently support and resolve issues and conflicts with minimal management oversight

• Microsoft Office – Advanced Excel skills, including experience with formulas, data analysis, and/or pivot tables; fluent with Microsoft Access, PowerPoint, Word, etc.

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: 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.