Network Operations Analyst/Provider Compliance Analyst

This role will assist internal and external business partners in all aspects of pharmacy operations and compliance, including fielding day to day pharmacy inquiries, managing pharmacy and pharmacy claims data, supporting tasks involving pharmacy credentialing and contracting, data analysis, and network compliance. The Network Operations Analyst role will work closely with our Independent Network Providers, primarily assisting with credentialing application reviews, claims monitoring, claims triage, and other ADHOC requests.

ESSENTIAL FUNCTIONS

• Works closely with our independent pharmacies assisting with day-to-day operations, including but not limited to, compliance concerns and requests, network participation, claims analysis and research, pharmacy communications and communications tracking, 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 SOPs / P&Ps 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 requests, escalations, and ADHOC research.
• Ensures network pharmacies adhere to and maintains compliance with state and federal regulations.
• Perform ad hoc analyses and assist with special projects, as needed.

Qualifications

• Bachelor’s degree preferred. HS Diploma required.
• At least 1-3 years related experience a plus
• 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 are essential.
• Comfortable communicating concerns, questions, and risk at all levels of the organization.
• Consistently maintain a positive, helpful, and 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: [email protected] for support. Do not email [email protected] 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.