Job Description
Product Management Lead Analyst - Centene Operations Management
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.
The Regulated Markets Centene Operations Management team is responsible for ensuring the execution of key operations accountabilities associated with all regulated lines of business including Medicare, Medicaid, and Marketplace (Exchange / Health Care Reform). The team supports Pharmacy Benefit Management (PBM) delegated responsibilities associated with regulatory requests (including audit support), issue management, adjustment processing, and regulatory communications.
The Lead Analyst will support initiatives to ensure member/client satisfaction, alignment with client contractual support and client retention. When necessary the analyst will also provide functional SME support to client facing discussions.
Key Responsibilities: - Provides advanced professional input to complex assignments/projects.
- Works autonomously, only requiring "expert" level technical support from others.
- Partners with internal Audit teams to notify Express Scripts of client audit needs, facilitate Client/Express Scripts preparation and support for audit scope and document completion of all audit deliverables and findings for all Medicare (CMS Program Audit, Data Validation, Acumen), Medicaid (Readiness Reviews, External Quality Review Organization (EQRO), Financial, Credentialing, Quality of Care) Marketplace (Market Conduct Exams, Quality of Care) audit types.
- Coordinates with subject matter experts to deliver response on all regulatory contract assessments, policy verifications, requests for information (RFI), and general inquiries for client's book of business.
- Facilitates the intake, triage, root cause analysis, mitigation, impact analysis and closure of all client issues associated with regulatory compliance.
- Process completion of all adjustment requests aligned with client specific request processes.
- Promotes the tracking and documentation of all team activities in associated systems.
- Supports the client Project Management Office (PMO) and Account Teams with function specific communications needs via account team/client inquiry, including deliverable reports and presentations.
- Compiles and evaluates data on the functional performance. Utilizes in-depth professional knowledge and acumen to develop models and procedures and monitor trends.
- Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.
- May assist, coordinate or lead portions of mid-size projects. Supports and provides direction to more junior professionals.
- Exhibits proven ability to work cross-functionally in development and execution of operational plans aligned to enterprise goals and in support of the needs of our clients.
- Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives.
Ideal Candidates will offer: - Bachelor's Degree with a preferred focus of Health Care Administration or Business
- At least one year experience in a health plan or PBM setting. Medicare, Medicaid and Marketplace experience a plus.
- Able to balance high priority, long-term projects with short-term, immediate deadlines
- Creative thinker and exceptional problem solving skills
- Ability to follow processes and document information consistently and timely to meet obligations
- Able to translate technical data concepts to business partners for understanding and alignment
- Proven ability to function in a heavily matrixed environment.
- Extensive knowledge of Microsoft Office products (particularly Excel, Word, Power Point, etc.)
- Experience leading projects and working with cross functional teams
Other Essential Skills: - Excellent process mapping and analysis skills
- Open communicator; excellent oral and written communication skills
- Ability to work effectively in dynamic, rapidly changing, team-based environment across multiple functions and in support of diverse regulatory obligations.
- Critical thinker and creative problem solver, who exercises good judgment in resolving difficult situations, prioritizes and can balance needs with enterprise objectives
- Ability to work in a fast-paced deadline-driven environment, and juggle multiple, sometimes competing, priorities and requirements
- Ability to motivate, influence and connect others
- Ability to influence direction and action; build and leverage internal relationships
- Goal oriented and personally accountable; resourceful and self-directed
- Adaptable and flexible; open minded, innovative and creative - seeks 'out of box' solutions
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.
Job Tags
Permanent employment, Contract work, Temporary work, Local area, Immediate start, Work from home, Flexible hours,