Operating Effectiveness Lead Analyst - eviCore - Remote - The Cigna Group
Bloomfield, CT
About the Job
Want to improve the health and vitality of those we serve? EviCore, a line of Business within the Cigna Group is hiring an Operating Effectiveness Lead Analyst. In this leadership role, you’ll be the point person and subject matter expert providing concierge level, expert guidance to our providers to ensure that their unpaid claims are remediated.
What you’ll do to make a difference:
+ Assists program leadership with providing leadership, oversight, and accountability for Claims program operations
+ Manage and track all issues from first report to resolution, while coordinating across departments
+ Maintains and improves operational performance of program in terms of efficacy for the client and efficiency for eviCore by monitoring and improving workflows
+ Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost
+ You’ll serve as a claim’s liaison between internal eviCore team and external providers/clients
+ Attend provider JOCs and provides proactive updates and deliverables
+ Develops clear communication plan and issue/action item tracking
+ Position works cross-functionally with client services, IT, compliance, program leads, provider and health plan operations, and implementation teams
+ Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures
+ Solves complex problems; Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others.
+ Analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements
+ Research best business practices within and outside the organization to establish benchmark data
+ Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Operating Effectiveness
Requirements:
+ High school diploma or GED required; bachelor’s degree preferred
+ 3+ years of experience leading process and quality improvement initiatives including driving the design and deployment of solutions, strongly preferred
+ 3+ years of experience in two or more of the following areas: project management, operations management, health services and managed care, medical claims operations, healthcare economics, or management consulting, strongly preferred
+ 3+ years of experience assessing operational risks for enhancements, projects, and integrations, strongly preferred
+ 3+ years of experience leading, coordinating and collaborate across multiple levels and departments of an organization to execute on key projects and initiatives, required
+ 3+ years of experience in Workflow and standards documentation, required
+ Proficient in Microsoft Office Suite; PowerPoint, Excel, Word, Visio, and Project, required
+ Proficiency in Smartsheet’s and SQL, preferred
+ Excellent verbal and written communication skills, required
+ 3+ years of concierge level client / vendor / provider support, required
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 72,100 - 120,100 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 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._
_Qualified applicants with criminal histories will be considered for employment in a manner_
_consistent with all federal, state and local ordinances._
_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._
What you’ll do to make a difference:
+ Assists program leadership with providing leadership, oversight, and accountability for Claims program operations
+ Manage and track all issues from first report to resolution, while coordinating across departments
+ Maintains and improves operational performance of program in terms of efficacy for the client and efficiency for eviCore by monitoring and improving workflows
+ Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost
+ You’ll serve as a claim’s liaison between internal eviCore team and external providers/clients
+ Attend provider JOCs and provides proactive updates and deliverables
+ Develops clear communication plan and issue/action item tracking
+ Position works cross-functionally with client services, IT, compliance, program leads, provider and health plan operations, and implementation teams
+ Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures
+ Solves complex problems; Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others.
+ Analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements
+ Research best business practices within and outside the organization to establish benchmark data
+ Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Operating Effectiveness
Requirements:
+ High school diploma or GED required; bachelor’s degree preferred
+ 3+ years of experience leading process and quality improvement initiatives including driving the design and deployment of solutions, strongly preferred
+ 3+ years of experience in two or more of the following areas: project management, operations management, health services and managed care, medical claims operations, healthcare economics, or management consulting, strongly preferred
+ 3+ years of experience assessing operational risks for enhancements, projects, and integrations, strongly preferred
+ 3+ years of experience leading, coordinating and collaborate across multiple levels and departments of an organization to execute on key projects and initiatives, required
+ 3+ years of experience in Workflow and standards documentation, required
+ Proficient in Microsoft Office Suite; PowerPoint, Excel, Word, Visio, and Project, required
+ Proficiency in Smartsheet’s and SQL, preferred
+ Excellent verbal and written communication skills, required
+ 3+ years of concierge level client / vendor / provider support, required
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 72,100 - 120,100 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 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._
_Qualified applicants with criminal histories will be considered for employment in a manner_
_consistent with all federal, state and local ordinances._
_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._
Source : The Cigna Group