Operations Lead Analyst, Enterprise Print & Distribution - Evernorth - Remote

Socket.dev; Town of Florida (NY); Hybrid; USD 63,000 - 104,000; Full time

Benefits offered by this job

Medical

Vision

Dental

Well-being programs

401(k)

Life insurance

Tuition reimbursement

Paid time off

Paid holidays

Leaves of absence

Job summary

The Cigna Group's Evernorth Health Services in New York, NY, seeks a senior operations professional to lead complex PBM-related projects within Pharmacy Operations. You will triage issues, analyze financial impact, and partner with cross-functional teams to drive timely remediation.

This role requires 3+ years in PBM, expert Excel, Six Sigma or similar, and strong communication. The position offers competitive benefits, an annual bonus plan, and opportunities for professional growth.

Qualifications

• 3+ years’ relevant experience in a Pharmacy Benefit Management (PBM) related role such as Operations, Quality, Implementation or Reporting Analytics.
• Expert level understanding of Pharmacy operations and financial acumen/claim processing knowledge.
• Strong analytical skills to assess/understand financial impacts and decision making abilities.
• Proven ability to facilitate issue/impact analyses and bring cross-functional teams together.

Responsibilities

• Lead and manage resolution of complex issues within the Pharmacy Reliability team, escalating as needed.
• Triage, research and resolve escalated client issues from business partners.
• Assess impact of pharmacy benefit design on costs, contracts, and legal implications.
• Communicate issues, impacts, and results to stakeholders and executive level teams.
• Collaborate with Customer Service, Claims, Client Implementation & Service, and PBM vendors to ensure timely and accurate reimbursements.
• Identify root causes and develop preventive measures for assigned client service issues.
• Maintain issue-tracking in SharePoint and coordinate remediation funding.
• Provide executive level communications for escalated issues.

Skills

PBM experience

Operations

Quality

Implementation

Reporting analytics

Analytical skills

MS Excel

Six Sigma

Problem solving

Decision making

Communication

Education

High School Degree or GED

Bachelor's degree preferred

Tools

ePro

BPL

CIT

Job description

POSITION SUMMARY

Provides advanced professional input to complex Operations Management assignments/projects. Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Business Operations. May lead projects or project steps within a broader project or have accountability for ongoing activities or objectives.

Primary Responsibilities

• Lead and manage the resolution of often complex issues involving multiple clients and customers that are reported to the Pharmacy Reliability team, escalating as appropriate for high risk or ongoing issues.
• Triage, research and resolve single member issues that require escalation support from business partners (i.e. Call Center)
• Use Pharmacy benefit design knowledge to assess and evaluate impact and implications for complex and/or multiple client issues from a cost, contractual and legal standpoint.
• Summarize, articulate, and explain the issue, impact reporting as well as identifying appropriate stakeholders and communicating results as needed.
• Partner with Customer Service, Claims Department, Client Implementation & Service, and PBM vendors to ensure reimbursement is completed timely and accurately for individual members and clients.
• Act with urgency to identify barriers and elevate as appropriate to drive engagement of proper business units and stakeholders to bring complex issues to resolution.
• Use best practices and knowledge to improve processes, products, and services
• Assist in identification of root cause and determination of future preventive measures for all assigned Client Service Issues.
• Develop strong partnerships with cross-enterprise partners in Pharmacy Operations, coordinating efforts to achieve goals, leveraging best practices.
• Calculate impact to clients, customers, and/or pharmacies using both internal and external claims reports
• Submit documents communicating impact to appropriate matrix partners to facilitate financial remediation
• Maintain and regularly update issue tracking ticket in SharePoint
• Manage and coordinate funding of remediation (DMR’s, P&L, E&O, etc.)
• Provide executive level communications for escalated issues.
• Analyze issues of increased complexity inquiries and determines appropriate technical area or vendor to solve problems.

Key Qualifications

• High School Degree or GED required. Bachelor’s degree preferred
• 3+ years’ relevant experience in a Pharmacy Benefit Management (PBM) related role required- i.e., Operations, Quality, Implementation or Reporting Analytics
• Working knowledge of internal Cigna systems: (i.e. ePro, BPL, CIT, etc. are preferred)
• Expert level understanding of Pharmacy operations
• Financial acumen/claim processing knowledge required
• Must be able to exhibit strong analytical skills to assess/understand financial impacts
• Must have strong decision making skills
• Must be able to facilitate issue/impact analysis discussions; making the complex simple to understand
• Proven experience in analytical thinking utilizing proficient technical skills with MS Excel (formulas, pivots, etc.)
• Strong critical thinking, resolving and negotiating skills.
• Experience applying logical problem solving methodologies (i.e. Six Sigma, Total Quality, etc.) to solve issues and identify root cause and improvement opportunities.
• Ability to navigate ambiguous scenarios which involve multiple organizational areas and bring those areas together for problem solving and process discussions.
• Demonstrated issue management/organizational skills; ability to plan for both the long and short term.
• Detail oriented, with proven ability to prioritize multiple tasks and adjust work to meet service standards.
• Must be able to work independently, with little supervision

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 62,600 - 104,300 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, click here.

• medical
• vision
• dental
• well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays
• leaves of absence

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 need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco‑free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally