Address
Form of workPOSITION SUMMARY
The Network Operations Advisor role is part of the Regulatory Compliance team that sits within the Network Compliance organization. The primary responsibility of this role is to manage a portfolio of complex escalated issues and formal complaints filed by state regulatory bodies, that require a high volume of issue research and cross functional engagement to support complaint response and resolution on a daily basis. Position will partner especially with Legal/Regulatory, Product, Pricing, Network Operations and Network Compliance teams. The successful candidate is a team player who is willing to collaborate within and across teams, has excellent verbal and written communication skills, attention to detail, provide time management, and excellent problem-solving abilities.
This role is required to work independently to lead, own and manage the assigned issue, including in depth research, engaging network SMEs across multiple teams, while also offering SME level support from a regulatory and compliance standpoint. This role is also required to champion cross-functional issue escalations/resolution; communicate progress and key milestones to appropriate internal partners in a timely manner.
ESSENTIAL FUNCTIONS
QUALIFICATIONS
Our Pharma & Retail Relations team plays a key role in keeping us at the forefront of the health care evolution. Team members oversee partnerships with Express Scripts' key supplier groups, including brand and generic pharmaceutical manufacturers, retail pharmacies and drug wholesalers. Successfully maintaining these relationships allows our 100 million patients access to the medicine they need at a price they can afford.
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.
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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.
The Network Operations Advisor role is part of the Regulatory Compliance team that sits within the Network Compliance organization. The primary responsibility of this role is to manage a portfolio of complex escalated issues and formal complaints filed by state regulatory bodies, that require a high volume of issue research and cross functional engagement to support complaint response and resolution on a daily basis. Position will partner especially with Legal/Regulatory, Product, Pricing, Network Operations and Network Compliance teams. The successful candidate is a team player who is willing to collaborate within and across teams, has excellent verbal and written communication skills, attention to detail, provide time management, and excellent problem-solving abilities.
This role is required to work independently to lead, own and manage the assigned issue, including in depth research, engaging network SMEs across multiple teams, while also offering SME level support from a regulatory and compliance standpoint. This role is also required to champion cross-functional issue escalations/resolution; communicate progress and key milestones to appropriate internal partners in a timely manner.
ESSENTIAL FUNCTIONS
- Evaluate incoming complaints to determine scope, impacted SMEs, and next steps.
- Conduct research on claims, provider engagement, client and network setups.
- Coordinate with Legal/Regulatory teams on strategic messaging.
- Draft, proofread and amend external facing documents.
- Assist in the evaluation of trends and escalations.
- Evaluate and execute efficiencies in data mining with a variety of system tools.
- Support additional special projects as needed.
- Serves as subject matter expert for team on analytics and technical support.
- Execution of assigned strategic work plan initiatives including but not limited to network development, implementing initiatives benefiting Express Scripts clientele and promoting Corporate and Departmental objectives.
QUALIFICATIONS
- Bachelor's degree in related field or at least 3-5 years of relevant experience.
- Knowledge of the health-care, PBM industry and products.
- Excellent oral, written communication and presentation skills.
- Problem solving and analytical skills.
- Project management/organizational skills.
- Ability to work cross-functionally to research and resolve complex client/provider issues.
- External Relationship building.
- Ability to manage simultaneous escalated issues with tight timelines.
- Working knowledge of MS Office applications, especially Excel, Word, PowerPoint
- Ability to adapt in a dynamic work environment, learn quickly, solve problems and make decisions with limited supervision.
- Demonstrated ability to manage projects, utilizing proven project management processes.
Strong leadership skills and the ability to effectively engage with cross-functional leadership.
Our Pharma & Retail Relations team plays a key role in keeping us at the forefront of the health care evolution. Team members oversee partnerships with Express Scripts' key supplier groups, including brand and generic pharmaceutical manufacturers, retail pharmacies and drug wholesalers. Successfully maintaining these relationships allows our 100 million patients access to the medicine they need at a price they can afford.
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.
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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.
