Network Operations Lead Analyst

Role Summary

• The Network Operations Lead Analyst provides critical analysis and resolution that enables automated provider selections. The analyst improves accuracy by enabling logic and controls to deliver consistent and accurate claim processing for our customers. This role provides root-cause analysis to resolve provider selection related issues within the HCPM selection platforms. This is done by performing research into selection logic defects and the data loaded. In addition, the analyst is a customer centric role required to increase the automation match rate and accuracy for improved service delivery. This expertise will be multi-faceted using critical thinking and technical expertise to resolve issues with minimal handoffs.
• The analyst will lead projects as a result of opportunities identified from team analysis. This requires working with operational readiness areas along with other critical matrix partners to ensure impacts (positive or negative) are understood.

Responsibilities

• Develop a strong understanding of the selection process, loading guidelines, and claim and provider storage applications. (HCPM, CPF, Proclaim, Facets, PowerMHS, and Data General)
• Develop a strong understanding of the enterprise pricing service (EPS) and how the provider selection service is strategically aligned to achieving accurate and flexible pricing of claims.
• Participate in requesting, implementing, and testing provider selection code enhancements and provider data structure changes.
• Assess impact and implications on the provider fallout teams from a cost and efficiency standpoint.
• Partner with analytics managers to help determine business requirements, project plans, establish priorities/risks, and successfully monitor progress.
• Provide immediate resolution and sustainable solutions in the HCPM provider selection service space to support inquires and defects from internal business partners.
• Continuously looks for opportunities in the end to end process and implements changes to improve the provider selection team’s effectiveness.
• Analyze audit and fallout data from a variety of sources. Compile and analyze results for identification of improvement opportunities.
• Augment and rectify any provider data issues that contribute to inaccuracies, issues or claim fallout.
• Provide measurement and cost saving support.
• Assist with streamlining or creating reports for the management team.
• Provide constant communication with operational and project leads to drive quality improvement.
• Successfully work with matrix partners to ensure that appropriate action is taken to address top error trends and to ensure that high potential process improvements are identified and implemented.

Qualifications

• Bachelor’s degree or equivalent work experience required
• 5 years of related experience in healthcare with exposure to project or analytical work preferred
• Self-starter with excellent written and oral communication skills
• Demonstrated critical thinking ability with independent thinking
• Strong leadership skills
• Strong interpersonal skills, excellent analytical, problem solving, and negotiating skills
• Excellent organizational and time management skills
• Experience with continuous quality improvement methods and tools (e.g., statistical process control, Six Sigma, etc.) highly preferred
• Comfortable with raising questions, issues, ideas or suggestions to co-workers of all levels across all organizations
• In-depth knowledge of HCPM/Activity Manager; the HCPM Provider Selection Service and CPF
• Knowledge of legacy claim engines that support our Proclaim, Facets, PowerMHS, Behavioral and Government services
• In depth knowledge and understanding of HCP Demographic Data and its influence on provider selection preferred
• Knowledge of provider data loading and management practices across all provider types preferred
• Some development and strong working knowledge of Microsoft Word, Excel, Access, and Powerpoint
• Knowledgeable of claim processing protocols and adjustments preferred
• Some SQL knowledge preferred

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 66,300 – 110,500 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 The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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.