Please note : This hybrid role will require the incumbent candidate to come into a local Cigna office 3 full days per week.

The incumbent candidate can be based out of the Bloomfield, CT, Scottsdale, AZ, Glendale, CA, Denver, CO, Washington, DC, Sunrise, FL, Chicago, IL, Baltimore, MD, Bloomington, MN, Morris Plains, NJ, Morristown, NJ, Philadelpha, PA, Chattanooga, TN or Plano, TX office.

Role Summary :

Serve as a member of the Enterprise Operations team who successfully implements and services new and renewing pharmacy clients.

The Member of the Enterprise Operations team is a client facing department within the Pharmacy Benefit and Clinical Services organization that will clarify client intent regarding technical business requirements, execute the client specific technical strategy, manage and execute client data file onboarding operations and file analyses, facilitate reporting and communications, gather specific client technical requirements, map client specific technical requirements in standard, as well as custom file layouts, and translate client specific technical requirements into Cigna operating systems.

This position will serve as the technical liaison between the client and Cigna Enterprise Operations and Pharmacy IT and be responsible for defining client technical requirements to bridge existing client and customer utilization history as part of the new client installation process.

This person will be responsible for developing relationships with external clients and customers, as well as internal matrix partners, inside and outside of Cigna Enterprise Operations.

Member of the Enterprise Operations will act as the central point of contact for client technical issues and resolution across all clients for all segments of business.

Responsibilities :

Client / Customer Centricity :

Interface with clients to define technical requirements for client implementations and provide overall support for all client technical requirements.

Onboard clients’ transactional data files to facilitate on-going claims adjudication and continuation of care.

Manage new clients’ file and disruption analyses and reporting to facilitate clients’ decisions around member communications and plan / clinical edit overrides.

Support reporting needs for Pharmacy Implementation Managers

Provide leadership using in-depth knowledge of platforms and experience in health care to translate custom business needs into project / systems specifications.

Fully support all aspects of new client system implementations from initial analysis, requirements definition and design through data transfers and file loads to certification, testing, and post-implementation support

Ensure client retention through supporting the client relationships and effectively managing customer issues.

Obtain a positive Cigna client reference for all clients implemented on the success of the implementation deliverable.

Support Cigna Sales strategies by becoming a trusted advisor and providing consultative services regarding operations to Sales and Pharmacy Benefits Advisory Board teams.

Create technical solutions that support the Client Implementation team as they address client issues, risk points and customer requirements.

Operations :

Manage the gathering and interpretation of technical requirements into efficient executable artifacts and drive scalable solutions through the complete software development lifecycle.

Partner with other stakeholders to streamline a corporate process for prioritizing and managing systems service and corrective action requests to improve first pass rate for systemic designs and implementations.

Estimate technical process scope and costs, manage process execution, and coordinate quality assurance and ongoing service support.

Establish economies of repetitive processes to achieve improved efficiencies and effectiveness of new client installations and support services for existing clients.

Improve quality of new pharmacy client implementations by providing input for creating comprehensive technical implementation Standard Operating Procedures

Create, facilitate, and report on all technical implementation metrics including, but not limited to effective date implementation, technical file load submission dates, client implementation survey scores, 100% referenceable clients, and reduction of implementation set-up Reliability tickets.

Develop / design and pull data for dashboard and operational reporting to help answer business / client-specific questions and metrics.

Adhere to Client Service & Operations organizational policies and procedures.

Develop processes and streamline operations to ensure optimal productivity by team, as well as ensure client and customer centricity.

Required Technical Skills :

Intermediate to advanced data analysis and reporting skills managing data files required.

Proficiency with SharePoint tools required.

Ability to understand and map both standard and custom file layouts (e.g., External Claims History Load, Prior Authorization Load (PA), Open Refill File / Tape Load (ORT), Accumulators) required.

Must be a good listener, fast learner and team player.

Qualifications :

Bachelor’s degree or 4 years of relevant work experience required. MBA preferred.

Pharmacy Benefit Management (PBM) or Healthcare implementation operations experience required.

Demonstrated ability to make decisions in a production environment with the ability to gather / synthesize information quickly, assess options, and recommend / implement solutions.

Experience within a high-volume production environment in measuring both productivity and quality are essential.

Highly organized with demonstrated ability to manage multiple priorities and execute tasks with strict timelines. Demonstrated experience in planning, coordinating and tracking multi-functional activities.

Excellent communication and interpersonal skills in order to work effectively with matrix business partners, clients and senior leaders, strong presentations skills to both clients and executive leadership.

Demonstrated ability to work under pressure and take initiative while working autonomously.

Ability to travel up to 25%

Last updated : 2024-05-17