Coverage Review Operations Director

4 days ago


St Louis, Missouri, United States The Cigna Group Full time
Coverage Review Operations Director

The Coverage Review Operations Director is responsible for the daily oversight and management of a large team of internal and external representatives. This role requires strong leadership and communication skills to ensure that the team is aligned with the company's goals and objectives.

Key Responsibilities
  • Provide direction and oversight to the team to ensure that prior authorization reviews and direct member reimbursement claims are processed in accordance with client benefit intent policies and regulatory requirements.
  • Develop and execute strategic operations roadmaps to improve operational efficiency and reduce costs.
  • Partner with outsourced leadership to ensure that Global Service Partners (GSPs) are motivated and receive proper direction to achieve top performance.
  • Manage operational results and outcomes, including quality, productivity, and service level agreements.
  • Identify opportunities for process improvement and work with partners to implement changes.
Requirements
  • Bachelor's Degree; Advanced degree strongly preferred.
  • 8 plus years of relevant experience; to include experience developing and executing core operations functions and strategies.
  • Experience with leading a large team overseeing broad scale operations with strong cross-functional partnerships.
  • Demonstrated effectiveness working in a highly matrixed organization.
  • Ability to manage change, timelines, and balance multiple deadlines in a fast-paced environment.
  • Advanced problem-solving skills and ability to work collaboratively through complex matters with innovative solutions.
Leadership Competencies
  • Delivers Results – Pushes team and cross-functional partners to deliver needed results in tough circumstances and expedited timelines.
  • Builds Effective Teams – Builds strong identity teams that apply their diverse skills and perspectives to achieve common goals.
  • Manages Complexity – Makes sense of complex and sometimes contradictory information to effectively solve problems.
  • Manages Ambiguity – Operates effectively and drives work forward even when things are not certain or there is no clear way forward.
  • Collaborates – Quickly builds partnerships and works collaboratively with others to ensure progress.


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