Cigna is hiring work from home in many states!
Cigna is a massive worldwide health services provider! Cigna makes over $100 billion dollars a year! Cigna is seeking remote Grievance Operations Lead Analysts in many states!
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SUMMARY
The Operations Lead Analyst will be accountable to support oversight and monitoring of individual Prescription Drug Plan (PDP) grievance operations, compliance with CMS requirements, mock audit support and CMS plan audits. Oversight of grievance operations to identify non-adherence to established processes as well as identify improvement opportunities. Report results through ongoing audit spreadsheets, dashboards and scorecards. This role includes vendor oversight & collaboration and coordination with other internal partners and other lines of business for consistent processes across grievance operations.
RESPONSIBILITIES
- Support daily oversight and monitoring of PDP grievances with the vendor, internal and external partners. Includes BPO vendor, Pharmacy Claim vendor (Express Scripts), and internal Cigna Government Business & matrix partners.
- Identify grievance trends/issues within grievance operations and Center for Medicare & Medicaid Services (CMS) complaints. Support root cause analysis; engage with other operational areas and partners as needed to remediate issues.
- Review Service Level Agreement (SLA) metrics on a monthly basis and work with vendor/matrix partners to address any issues impacting grievance operations.
- Perform ongoing review for implemented process updates and/or technology enhancements through quality audits, calibration sessions, etc.
- Conduct ongoing audits and monitoring to ensure adherence with established policies and procedures and to validate compliance with CMS requirements.
- Support the annual review of grievance policies & procedures/job aids or as needed for new or updated processes or enhancements.
- Support review of annual training materials and any ad-hoc or refresher training materials, as needed.
- Work with internal team & vendor to identify improvement opportunities and track through implementation.
- Support projects and grievance initiatives both internally and with vendor(s).
- Participate in defining and reviewing business requirements documentation, user acceptance testing, checkout and signoff in of system enhancements, production fixes, and/or business process improvements.
- Support AEP and 1/1 readiness activities for Grievance operations.
- Participate in and actively support all CMS, external, and internal audit activities.
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QUALIFICATIONS
- Bachelor’s degree or equivalent experience
- 3-4 years of relevant Medicare (Part D and/or Part C) or other government program experience and/or Customer Service
- Detailed understanding of CMS regulations and adherence to these standards relating to all aspects of Medicare business.
- Strong analytical, root cause analysis, and problem solving skills
- Detail-oriented with emphasis on quality/accuracy
- Excellent organization skills
- Ability to manage multiple competing priorities and deliverables
- Excellent oral & written communication skills and the ability to communicate and interact at various levels and functions within the internal and vendor organizations
- Proficiency with Microsoft Word, Excel, Outlook, PowerPoint
- Self-Learner, independent strategic and creative thinker
- Make Extra $2000/Month from Home
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- Survey Junkie: Make $5-$25 from home in your spare time the EASY way: try new products, give your opinion and take part in focus groups. Join Survey Junkie Now.
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