Network Operations Senior Analyst, Provider Compliance – Express Scripts – Remote

The Cigna Group; United States; Hybrid; USD 62,000 - 104,000; Full time

Job summary

The Cigna Group, through Express Scripts networks, seeks a Provider Compliance Senior Analyst to support daily workflows around provider termination and related investigations. You will collaborate with multiple groups to gather and report termination data and assist with client requests intersecting pharmacy operations and compliance.

The role requires a bachelor’s degree (minimum HS diploma) and at least 2 years of relevant experience, with strong communication and analytical skills.

Qualifications

• Bachelor’s degree in related field preferred; HS Diploma required.
• At least 2 years of relevant work experience.
• Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Strong written and verbal communication skills.
• Excellent follow-through, attention to detail, and ability to manage multiple tasks.

Responsibilities

• Ensure network providers maintain compliance with state and federal regulations, as well as ESI’s Provider Manual and Provider Agreement.
• Liaison for internal Compliance related inquiries and projects.
• 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.
• Thrive in a high-pressure environment with multiple competing priorities.

Skills

Communication skills

Problem solving

Independent thinking

Strategic thinking

Education

Bachelor’s degree

HS Diploma

Tools

Microsoft Office Suite

Job description

Position Summary:

Provider Compliance works to ensure the integrity of the Express Scripts networks for all Clients and Members. The Provider Compliance Senior Analyst is responsible for assisting in the daily support, and preparation, of the provider termination process. This position will work cross functionally with several different groups collecting and reporting on termination information, as well as support investigations of pharmacy noncompliance, and collaborative support Client Account Team requests that intersect with pharmacy operations and compliance.

Essential Functions:

• Ensure network providers maintain compliance with state and federal regulations, as well as ESI’s Provider Manual and Provider Agreement.
• Liaison for internal Compliance related inquiries and projects
• 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
• Thrive in a high-pressure environment with multiple competing priorities

Qualifications:

• Bachelor’s degree in related field preferred, HS Diploma required
• At least 2 years of relevant work experience
• Proficient with Microsoft Office suite (Word, Excel, PowerPoint and Outlook)
• Strong written and verbal communication skills
• Exceptional follow through skills, an attention to detail and the ability to handle multiple tasks and meet daily deadlines
• Ability to demonstrate initiative and independent thinking
• Ability to think strategically while solving tactical challenges
• Demonstrated ability to work with cross-functional departments to resolve issues
• Detail oriented with strong analytical and problem-solving skills
• Ability to adapt in a dynamic and fast-paced work environment and make independent decisions

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 62,200 – 103,600 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.

At The Cigna Group, 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs.

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.

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.