Business Analyst – Cigna Remote Jobs

Job Type: Business Analyst from home
Location: Georgia work from home
Company: Cigna

Responsibilities:

• Having depth or breadth of technical expertise in pharmacy operations.
• Fulfills specialized, delegated, sophisticated administrative, technical, or operational tasks as directed by the manager.
• Examines operational documents before submission and confirms their internal coherence, completeness, and accuracy; modifications are made.
• Brings something to the table in terms of output levels, efficient processing controls, and related reporting in accordance with established standards.
• Contributes significantly to the planning and goals of the department.
• Assures the achievement of production goals and targets and the implementation of efficient processing controls.
• Provide complicated operations management assignments and projects advanced professional input.
• Planning ahead and anticipating demands and problems are essential components of tasks.
• Resolves non-routine concerns escalated by team members who are less experienced.
• Functions independently, requiring only “expert” level technical assistance from outsiders.
• Creates and keeps up resources for a designated group.
• Proactive teaching, direction, and advice to the team’s more junior members.
• Demonstrates judgment in the assessment, choice, and adaption of both common and sophisticated techniques and procedures.
• Uses extensive professional expertise and insight to keep an eye on business operations trends.
• May be responsible for continuing operations or goals or lead projects or project milestones inside a larger project.
• Discovers ways to integrate or streamline departmental operational processes.

Fundamental Duties:

• Responsible for resolving member issues (complaints, CTMs, etc.)
• To identify the source of the issue and the best course of action, analyze member complaints.
• Manage Member complaints and questions that are escalated internally for resolution, ensuring that the root cause, response, and resolution have been examined and approved.
• Manage Member grievances and queries that have been escalated to PBM for resolution, including root cause analysis and approval of PBM response and resolution.
• Follow internal and CMS rules for handling complaints and questions.
• Find ways to cut down on complaints
• resolve unusual problems that more junior team members have elevated
• Keep precise and comprehensive metrics for the volume, nature, and timing of Member complaints.
• As required, assists the manager with strategic priorities.

Requirements:

• Strong and established communication skills, including the ability to explain ideas succinctly and clearly to a variety of audiences, and to negotiate successfully with a variety of stakeholders.
• 5+ years of combined experience working in a customer service, claim, appeal, or prior authorization function related to Medicare Part D benefits.
• Thorough understanding of claim adjudication procedures and Medicare Part D CMS regulations.
• The capacity to analyze complicated data.
• Autonomous working skills.
• Ability to accept new responsibilities and tasks.
• Functional abilities to manage shifting and competing priorities.
• A track record of success working with stakeholders in business and information technology and cross-functional teams.
• Knowledge of pharmacy claim resolution and analysis.
• Preference for a bachelor’s degree or comparable experience.
• Preferable: recognized professional pharmacy certification, either current or prior.

Whether you intend to work from home on a regular basis or infrequently, you must have an internet connection from a cable broadband or fiber optic internet service provider with minimum download and upload speeds of 10 Mbps and 5 Mbps, respectively.
We plan to give a pay range of between 70,800 and 118,000 USD per year for this role, based on relevant aspects like experience and location.
Additionally, it is anticipated that this position will qualify for the yearly bonus program.

We want you to feel balanced, safe, and healthy. You will therefore benefit from a wide variety of advantages with an emphasis on promoting your overall health. You will be provided with a number of health benefits beginning on the first day of your job, including medical, vision, dental, well-being, and mental health programs. In addition, we provide a 401(k) with company match, life insurance paid for by the firm, tuition reimbursement, at least 18 days of paid vacation per year, and paid holidays.