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Network Operations Analyst
1 month ago
JOB SUMMARY:
This role will assist internal and external business partners in all aspects of Pharmacy operations including: Credentialing, re-credentialing, provider compliance, provider contracting, network support, and day to day pharmacy inquiries. The Network Operations Analyst role will work closely with our Independent Network Providers, primarily assisting with application questions, solicitations, claims triage, and other ADHOC requests.
ESSENTIAL FUNCTIONS:
- Works closely with our independent providers assisting with day to day operations, including but not limited to: application and credentialing support, Network participation, Network rejects, claims research, and triage.
- Participate in internal and cross functional meetings, assisting with development, design, and testing of our new business applications.
- Assist with creation and review of internal SOP's/P&P's to ensure processes are accurately documented and followed through day to day business interactions.
- Assist Client Account Teams and other cross functional partners with pharmacy recruitments, escalations, and ADHOC research.
- Ensures network providers adhere to and maintains compliance with state and federal regulations.
- Provides support to client and internal audit functions.
- Perform ad hoc analyses and assist with special projects, as needed
QUALIFIED CANDIDATES WILL HAVE A COMBINATION OF THE FOLLOWING:
- Bachelor's degree preferred
- Strong analytical, planning, problem identification and resolution skills required
- Ability to work in a fast-paced environment and multi-task across multiple deadlines and deliverables, often under uncertain or ambiguous circumstances
- Excellent communication, organizational, and time management skills essential
- Comfortable communicating concerns, questions, and risk at all levels of the organization
- Consistently maintain a positive, helpful, engaged attitude
- Self-starter that can independently support and resolve issues and conflicts with minimal management oversight
- Microsoft Office – Basic Excel skills, including experience with formulas, data analysis, and/or pivot tables; fluent with Microsoft Access, PowerPoint, Word, etc.
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.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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: for support. Do not email 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.
