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

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.

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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