Express Scripts Pharmacy Benefit Services
Product Management Senior Advisor, Claims Transactions and Adjustments - Express
Express Scripts Pharmacy Benefit Services, Saint Louis, Missouri, United States, 63146
Overview
Product Management Senior Advisor, Claims Transactions and Adjustments – Express Scripts – Hybrid Join to apply for the Product Management Senior Advisor, Claims Transactions and Adjustments role at Express Scripts Pharmacy Benefit Services. Responsibilities
Serve as the Regulated Markets business owner for Claim and Adjustment data provided to clients. Meet with account teams and clients, educating how data claim and adjustment data is provided and how to understand and use the data. Understand project changes due to new or changing regulations and the impact to data and files provided internally and to clients. Establish a working partnership and process flow between the client, account management and data analytics team(s). Gather business requirements and define alignment on functional requirements and rules. Analyze trends and data to develop recommendations to ensure client needs, compliance metrics, and internal support are met. Ensure internal/external policies and procedures are documented, maintained, and followed. Understand and use system tools to research and resolve issues and concerns. Cross-train and support other team initiatives where appropriate. Exhibit problem solving capabilities in a complex environment. Participate in cross-functional projects or work teams. Interact with clients/account teams to communicate information about areas of expertise, educate on processes, troubleshoot concerns, and manage expectations with appropriate follow-up. Position Details
Gtabs/Regulated Markets business owner for Claim and Adjustment data provided to clients (same as Responsibilities). Meet with account teams and clients, educating how data is provided and how to use the data. Understand regulatory changes and impacts to data/files. Establish partnerships and process flows between client, account management and data analytics teams. Gather business requirements and align functional requirements and rules. Analyze trends and data to support client needs and internal goals. Document and follow internal/external policies and procedures. Use system tools to research and resolve issues. Cross-train and support other initiatives; participate in cross-functional teams. Engage with clients/account teams to educate and troubleshoot as needed. Qualifications
College degree or equivalent experience preferred. 5 or more years of work experience, preferably in business analysis. Regulated Markets experience preferred. Familiarity with pharmacy adjudication and other PBM operations. Proficient in collecting and analyzing large data sets. Strong strategic, analytical, problem solving, and project management skills. High attention to detail and ability to manage multiple priorities. Customer-focused with the ability to work cross-functionally at all levels. Ability to see business needs outside of one’s own area and execute tactics under a strategic vision. SQL skills are highly desirable. Compensation and Benefits
For this position, salary is anticipated to be 110,700 - 184,500 USD per year, depending on experience and geographic location. This role is anticipated to be eligible for an annual bonus plan. We offer a comprehensive benefits package starting day one, including medical, vision, dental, well-being and behavioral health programs, 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. 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 health more accessible. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, pregnancy or related conditions, veteran status, religion, national origin, or other protected characteristics in accordance with applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email SeeYourself@cigna.com for support. The Cigna Group has a tobacco-free policy where permitted by law. Qualified applicants with criminal histories will be considered in accordance with laws.
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Product Management Senior Advisor, Claims Transactions and Adjustments – Express Scripts – Hybrid Join to apply for the Product Management Senior Advisor, Claims Transactions and Adjustments role at Express Scripts Pharmacy Benefit Services. Responsibilities
Serve as the Regulated Markets business owner for Claim and Adjustment data provided to clients. Meet with account teams and clients, educating how data claim and adjustment data is provided and how to understand and use the data. Understand project changes due to new or changing regulations and the impact to data and files provided internally and to clients. Establish a working partnership and process flow between the client, account management and data analytics team(s). Gather business requirements and define alignment on functional requirements and rules. Analyze trends and data to develop recommendations to ensure client needs, compliance metrics, and internal support are met. Ensure internal/external policies and procedures are documented, maintained, and followed. Understand and use system tools to research and resolve issues and concerns. Cross-train and support other team initiatives where appropriate. Exhibit problem solving capabilities in a complex environment. Participate in cross-functional projects or work teams. Interact with clients/account teams to communicate information about areas of expertise, educate on processes, troubleshoot concerns, and manage expectations with appropriate follow-up. Position Details
Gtabs/Regulated Markets business owner for Claim and Adjustment data provided to clients (same as Responsibilities). Meet with account teams and clients, educating how data is provided and how to use the data. Understand regulatory changes and impacts to data/files. Establish partnerships and process flows between client, account management and data analytics teams. Gather business requirements and align functional requirements and rules. Analyze trends and data to support client needs and internal goals. Document and follow internal/external policies and procedures. Use system tools to research and resolve issues. Cross-train and support other initiatives; participate in cross-functional teams. Engage with clients/account teams to educate and troubleshoot as needed. Qualifications
College degree or equivalent experience preferred. 5 or more years of work experience, preferably in business analysis. Regulated Markets experience preferred. Familiarity with pharmacy adjudication and other PBM operations. Proficient in collecting and analyzing large data sets. Strong strategic, analytical, problem solving, and project management skills. High attention to detail and ability to manage multiple priorities. Customer-focused with the ability to work cross-functionally at all levels. Ability to see business needs outside of one’s own area and execute tactics under a strategic vision. SQL skills are highly desirable. Compensation and Benefits
For this position, salary is anticipated to be 110,700 - 184,500 USD per year, depending on experience and geographic location. This role is anticipated to be eligible for an annual bonus plan. We offer a comprehensive benefits package starting day one, including medical, vision, dental, well-being and behavioral health programs, 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. 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 health more accessible. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, pregnancy or related conditions, veteran status, religion, national origin, or other protected characteristics in accordance with applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email SeeYourself@cigna.com for support. The Cigna Group has a tobacco-free policy where permitted by law. Qualified applicants with criminal histories will be considered in accordance with laws.
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