Individual and Family Plans(IFP)/ACA Reconciliation Lead Analyst

4 weeks ago

Remote, Oregon, United States The Cigna Group Full time
The job profile for this position is Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

Our people make all the difference in our success.

Role Summary:

Help Cigna Healthcare provide high quality affordable coverage to some of our country's most vulnerable citizens while being good stewards of federal tax dollars by becoming a part of a small team that supports Affordable Care Act for the Individual and Family Plan segment. The ACA Reconciliation Lead Analyst will provide oversight of a third-party administrator that is responsible for enrollment, billing, and data reconciliation with Federal and State Healthcare Marketplaces. Key responsibilities include researching and resolving individual customer issues, driving improvements through process and technology enhancements, developing key reporting and other activities that ensure Cigna Healthcare executes delegated entity oversight, while compliantly delivering the best quality service for our customers and stakeholders.

Responsibilities:

  • Maintain a current knowledge of all federal or state specific regulations and sub-regulatory guidance as it relates to Federally Facilitated or State Based individual insurance exchanges and reconciliation programs.
  • Act as a subject matter expert for Affordable Care Act Marketplace Enrollment and Policy Based Payments including federal and state regulations and sub regulatory guidance, transactional processing, and business processes.
  • Ensure compliance with all federal and state regulations.
  • Research and resolve enrollment or financial reconciliation discrepancies to provide root cause analysis and trending to drive Enrollment Alignment Performance metric attainment, improve first touch resolution rates, decrease time to resolution across the federally facilitated and state-based marketplaces.
  • Support oversight of third-party administrator by maintaining complete and accurate reconciliation file inventories and execution status.
  • Support oversight of third-party administrator by identifying and auditing statistically valid discrepancy resolution actions and providing results and trending.
  • Partner with enrollment and billing vendor, Cigna Group matrix partners and Federal/State marketplace representatives to analyze and resolve enrollment and financial discrepancies uncovered during the monthly reconciliation process between the Healthcare Marketplace and Cigna Healthcare
  • Support the development and maintenance of critical documents including policies, standard operating procedures, business rules, and technical specifications.
  • Support and deliver accurate and timely weekly and monthly reporting including but not limited to various reconciliation metric scorecards and progress reports.
  • Communicate the status of reconciliation efforts, including all remediation, efforts to cross functional matrix partners and leadership.
  • Use data-based analysis to prioritize and drive decreased disjoint metrics and increased operational efficiency.
  • Partners with operational and information technology teams to influence, develop and implement technology and business processes that increase operational oversight of reconciliation processes, improves reconciliation rates, decreases time to resolution, reduces operational costs, ensures data consistency and availability to all key stakeholders, supports growth scalability, and enables corporate or statutory audits.

Qualifications:

  • Bachelor's degree required or 3-5 years of relevant work experience required
  • 2+years of healthcare insurance business experience required
  • Previous experience with Affordable Care Act Individual marketplace business enrollment required
  • Detail orientation with good analytical and problem-solving skills
  • Strong written and verbal communication skills
  • Strong organizational and interpersonal skills
  • Self-motivated learner with the ability to learn on the fly
  • Ability to work independently and in conjunction with co-workers of all levels
  • Demonstrated ability to drive results required
  • Comfortable with raising questions, issues, ideas, or suggestions to co-workers of all levels across all organizations
  • Act with a sense of urgency to research questions or issues brought by the team
  • Proficiency with Microsoft products including Excel, Word, Power Point and Outlook
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 61, ,000 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.

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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

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