Operations Lead Analyst, Specialty Pharmacy Programs - Evernorth Health Services-Hybrid

Evernorth Health Services; Independence (OH); Hybrid; USD 61,000 - 102,000; Full time

Job summary

Evernorth Health Services is seeking an Operations Lead Analyst to support specialty pharmacy savings research and trend monitoring. The ideal candidate will excel in dynamic environments, possess strong analytical skills, and demonstrate effective communication with various teams. Join a dedicated team focused on improving health outcomes and achieve professional growth with competitive benefits.

Benefits

Comprehensive health benefits

401(k) with company match

Tuition reimbursement

Paid time off and holidays

Qualifications

• High School Diploma required; college education preferred.
• Expertise in working with numbers and calculations.
• Proven ability to manage multiple assignments.

Responsibilities

• Collaborates with various teams to support savings tracking.
• Reviews claims data to ensure accuracy in savings reports.
• Provides feedback and quality reviews to staff.

Skills

Time management

Organizational skills

Communication skills

Analytical thinking

Attention to detail

Education

High School Diploma or equivalent

Tools

MS Office applications

Job description

Operations Lead Analyst, Specialty Pharmacy Programs - Evernorth Health Services-Hybrid

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Job Summary

The Operations Lead Analyst is an organized, analytical thinker who is responsible for the focus of supporting medical specialty pharmacy redirection savings research, calculation, monitoring, and trend tracking. We are seeking a talented Medical Savings Lead Analyst who has the profile of a collaborative professional who excels in dynamic, sometimes ambiguous and complex activities by taking ownership, driving action and ensuring results. Able to take direction and respond quickly to both planned and unplanned activities to ensure results. This individual provides advanced professional input to complex Operations Management / Finance Operations 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 / Finance Operations. May lead projects or project steps within a broader project or have accountability for ongoing activities or objectives. May assist in business processing, service levels and reporting.

Job Summary

The Operations Lead Analyst is an organized, analytical thinker who is responsible for the focus of supporting medical specialty pharmacy redirection savings research, calculation, monitoring, and trend tracking. We are seeking a talented Medical Savings Lead Analyst who has the profile of a collaborative professional who excels in dynamic, sometimes ambiguous and complex activities by taking ownership, driving action and ensuring results. Able to take direction and respond quickly to both planned and unplanned activities to ensure results. This individual provides advanced professional input to complex Operations Management / Finance Operations 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 / Finance Operations. May lead projects or project steps within a broader project or have accountability for ongoing activities or objectives. May assist in business processing, service levels and reporting.

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.

The Clinical Care Management Team drives improved health outcomes, affordability, and satisfaction by engaging our customers/clients/providers, developing clinical polices/guidelines/meaningful measurements, aligning incentives, and building personal connections. This approach helps ensure that we are supporting Cigna's enterprise goals of putting the needs of our customers at the center of all we do, being the industry’s undisputed partner of choice, and accelerating the pace of the innovative change. We have an opening for a Medical Savings Lead Analyst who will be aligned to Specialty Pharmacy with focus of supporting medical specialty pharmacy redirection savings research, calculation, monitoring, and trend tracking. We are seeking a talented Medical Savings Lead Analyst who has the profile of a collaborative professional who excels in dynamic, sometimes ambiguous and complex activities by taking ownership, driving action and ensuring results. Able to take direction and respond quickly to both planned and unplanned activities to ensure results.

Summary

This role reports into the Clinical Care Management Team and will work directly in collaboration with leadership, medical specialty pharmacy operations teams, and Medical Economics. The individual supports the research, tracking, maintenance, and review of savings calculation and reporting. The role will also support client program related charge escalations and monitoring of claim payment for denied services. Additionally, support the structure and tracking of single case agreement implementation. The role is part of a larger medical specialty pharmacy team working within a matrix environment collaborating with leadership, medical injectable workgroups, pharmacy teams, and across various functional areas both internal and external partners including eviCore.

Responsibilities

• Collaborates with the Program Management Senior Manager, Clinical Program Managers, and specialty pharmacy operational team and Medical Economics.
• Reviews multiple platforms to obtain cost detail via claims, reports, etc., to accurately review and support savings details captured for the programs.
• Supports verification of reported savings to ensure accuracy.
• Provides support, random quality review and feedback to staff around savings calculations and details.
• Collaborates with leadership and peers to track and trend work processes requiring tool changes or process improvement.
• Utilize effective communication, courtesy and professionalism in all interactions, both internally and externally
• Perform additional duties as appropriate to meet the needs the specialty pharmacy programs
• Recommends changes in processes in collaboration with operations team based on outcome of projects, policy updates or business strategies.
• Works with operations partners to ensure successful workflow implementations.
• Provides clear communication to ensure barriers/obstacles to continuous quality improvement are removed and necessary support is provided.
• Maintains a positive working relationship with business partners, teammates and matrix partners.
• Coordinates the development, implementation, and maintenance of on-going program aspects
  
  

Requirements

• High School Diploma or equivalent
• Excellent time management, prioritization, and organizational skills
• Strong oral and written communication skills, with a strong background in working with numbers/mathematics.
• Detailed oriented and able to pivot and communicate at a high-level to leadership teams.
• Consistently dependable, self-motivated, flexible, and highly driven individual.
• Willing to develop knowledge and experience to provide subject matter expertise in response to day to day program and related issues.
• Ability to work independently or in a team, set priorities, and meet deadlines consistently
• Ability to work a flexible schedule to meet the needs of the department
• Has a good attitude and knows how to make work enjoyable
  
  

Preferred Qualifications

• College education via associates or higher degree.
• Knowledge of Cigna's basic clinical programs
• Knowledge of Cigna's claim platforms
• Working knowledge of Specialty Pharmacy program and terminology, specialty injectable medications, Cigna Coverage Review Department (CCRD), appeals, and/or utilization management ideal
• Knowledge of and experience with MS Office applications including Word, Outlook, Excel, PowerPoint and SharePoint are critical; with the demonstrated ability to produce professional documents.
• Proven track-record in managing multiple assignments simultaneously.
  
  

Must be available to work the following work schedule: Mon-Fri 8am-5pm EST

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 61,200 - 102,000 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 Group.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: [e-mail] for support. Do not email [e-mail] 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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Manufacturing

• Industries

  Hospitals and Health Care

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