JOB SUMMARY:

This role will assist internal and external business partners in all aspects of Pharmacy operations including: Credentialing, re-credentialing, provider compliance, provider contracting, network support, and day to day pharmacy inquiries. The Network Operations Analyst role will work closely with our Independent Network Providers, primarily assisting with application questions, solicitations, claims triage, and other ADHOC requests.

ESSENTIAL FUNCTIONS:

Work closely with our independent providers assisting with day-to-day operations, including but not limited to application and credentialing support, network participation, network rejects, claims research, and triage.

Participate in internal and cross functional meetings, assisting with development, design, and testing of our new business applications. 

Assist with creation and review of internal SOP’s/P&P’s to ensure processes are accurately documented and followed through day-to-day business interactions. 

Assist Client Account Teams and other cross functional partners with pharmacy recruitments, escalations, and ADHOC research.

Ensure network providers adhere to and maintains compliance with state and federal regulations.

Provide support to client and internal audit functions.

Perform ad hoc analyses and assist with special projects, as needed

QUALIFIED CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING:

Bachelor’s degree preferred

Strong analytical, planning, problem identification and resolution skills required

Ability to work in a fast-paced environment and multi-task across multiple deadlines and deliverables, often under uncertain or ambiguous circumstances

Excellent communication, organizational, and time management skills essential

Comfortable communicating concerns, questions, and risk at all levels of the organization

Consistently maintain a positive, helpful, engaged attitude

Self-starter that can independently support and resolve issues and conflicts with minimal management oversight

Microsoft Office – Basic Excel skills, including experience with formulas, data analysis, and/or pivot tables; fluent with Microsoft Access, PowerPoint, Word, etc.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.