Provider Relations Sr. Analyst - Remote

OVERVIEW:

This role is an integral part of Provider Relations & Operations aligned in supporting the Medicare Advantage provider community driving an improved provider experience for providers in an assigned market. Primary responsibilities include providing issue resolution for escalated inquiries in accordance with standard operating procedures, to include, thorough research and investigation of the issue, tracking interactions, collaborating with matrix partners, and performing critical thinking methodologies for root cause analysis and prevention of recurrence. In addition this role will have external provider facing responsibilities communicating and education providers.

RESPONSIBILITIES:

• Supports an intake process to review and resolve provider inquiries for an aligned market(s) includes research, root cause, resolution and/or triage to appropriate team in timely manner
• Accountable to servicing the provider to include face to face education, root cause analysis, and resolution.
• Initiates and maintains effective channels of communication with internal matrix partners.
• Manage regulatory and escalated matters to defined service level agreements
• Effectively engage in face-to-face, virtual and written communication
• Collaborate internally to share provider feedback and assist with strategies to help mitigate downward trends and expand momentum on positive trends
• Educate providers on Cigna's business objectives, standard operating procedures, policies and programs available through tools such as Cigna Network Newsletter, vendor updates, coverage policies and digital solutions
• Participates, collaborates, and supports strategic projects as determined by Medicare Provider Relations Operations Manager
• Serves as a provider advocate both internally and externally
• Participate in market and team meetings to share findings.
• Monitors and tracks all service issues and inquiries in the appropriate tools.
• Responsible for meeting internal metrics around service goals
• Other duties as assigned

QUALIFICATIONS:

• Bachelor's degree or higher strongly preferred or equivalent work experience required
• 3+ years of Medicare Claim, Network Operations, or Contracting experience preferred
• Knowledgeable with Medicare contracts and associated provider issues preferred
• Experience with QNXT, ONBASE, and Facets prefeerred.
• Experience with MS Office Suite - Word, Excel, Outlook and PowerPoint preferred
• Ability to effectively work within a heavily matrixed and culturally diverse environment
• Ability to problem solve
• Ability to manage multiple priorities
• Ability to learn and apply quickly
• Strong collaboration, communication and listening skills
• Strong planning and organization skills
• Flexibility as we grow new tools and implement process improvement
• Minimum 25% travel may be required

CORE COMPETENCIES:

Collaboration, Plans and Aligns, Manages Complexity, Courage,

Communicates Effectively, Interpersonal Savvy, Tech Savvy, Demonstrates Self-Awareness, Ensuers Accountability, Drive Results, Customer Focus,

Optimize Work Processes