Provider Compliance Senior Analyst - Express Scripts - Remote

UnitedHealth Group; United States; Remoto; USD 62.000 - 104.000; Tempo pieno

Descrizione del lavoro

The Cigna Group (Evernorth Health Services) invites a Compliance and Operations Specialist to partner with pharmacy networks, research complex matters, and implement improved processes. You will analyze risks, coordinate cross-functional projects, and help audits and training efforts.

This role emphasizes data-driven decision making, strong communication, and the ability to drive operational excellence in a regulated healthcare environment.

Competenze

• 3 years of experience in pharmacy benefit management, pharmacy networks, healthcare operations, compliance, or related field.
• Strong analytical, critical-thinking, and decision-making skills with ability to translate research into practical recommendations.
• Clear written and verbal communication across organizational levels.

Mansioni

• Partner with contracted pharmacy providers and internal teams to research and resolve complex compliance and operational matters.
• Lead or contribute to cross-functional projects that design, test, and implement business applications and process improvements.
• Analyze complex issues, identify risks, and turn findings into timely recommendations and solutions.
• Monitor network provider compliance with state and federal requirements and internal policies.
• Support audits by preparing information and coordinating responses.

Conoscenze

Analytical skills

Communication

Project coordination

Microsoft Excel

Formazione

Bachelor's degree

Strumenti

PowerPoint

Word

Access

Descrizione del lavoro

Help protect the integrity of Express Scripts’ pharmacy networks and the experience we deliver to clients and members. In this role, you will solve complex compliance and operational challenges, strengthen provider oversight, and help teams improve how work gets done. You will partner across the business, use data and technology thoughtfully, and bring the judgment and curiosity of an ambitious and compassionate expert.

Responsibilities

• Partner with contracted pharmacy providers and internal teams to research and resolve complex compliance and operational matters.
• Lead or contribute to cross-functional projects that design, test, and implement business applications, technology solutions, and process improvements.
• Analyze complex issues, identify risks and opportunities, and turn findings into clear, timely recommendations and solutions.
• Improve processes by simplifying work, automating workflows, and strengthening alignment across teams and partners.
• Monitor network provider compliance with applicable state and federal requirements, internal policies, and established procedures.
• Support client, internal, and other applicable audits by preparing information, coordinating responses, and addressing operational needs.
• Create, review, and maintain standard operating procedures, policies, training materials, and other process documentation.
• Share recommendations, concerns, and operational risks with the right stakeholders while building trusted cross-functional relationships.
• Promote operational excellence through continuous improvement, effective use of technology, and consistent execution.

Required Qualifications

• 3 years of experience in pharmacy benefit management, pharmacy networks, healthcare operations, compliance, or a related field.
• Strong analytical, critical-thinking, problem-solving, and decision-making skills, including the ability to translate complex research into practical recommendations.
• Ability to independently manage multiple priorities, deadlines, and deliverables in a fast-paced environment with changing or unclear needs.
• Clear written and verbal communication skills, with the ability to raise questions, recommendations, concerns, and risks across levels of the organization.
• Strong organization, time management, attention to detail, sound judgment, and the ability to know when to act independently, collaborate, or elevate.
• Advanced Microsoft Excel skills, including formulas, data analysis, and pivot tables, plus proficiency with PowerPoint, Word, Access, and related business applications.

Preferred Qualifications

• Bachelor’s degree.
• Experience with regulatory requirements and industry standards related to accreditation, credentialing, delegation, or oversight.
• Experience improving processes, supporting audits, developing procedures or training, or implementing technology solutions in a regulated environment.

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.

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 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 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.