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The Regulated Markets Services team is responsible for ensuring the execution of key operations accountabilities associated with all regulated lines of business including Medicare, Medicaid, and Marketplace (Exchange / Health Care Reform). The team supports Pharmacy Benefit Management (PBM) delegated responsibilities associated with Call Center and Grievances oversight, regulatory audit support, issue management and analytics.

The Senior Advisor’s primary role will be to support Call Center functions as it relates to initiatives to ensure member/client and internal satisfaction and alignment with both regulatory and client contractual support.

Key Responsibilities:

• Provides advanced professional input to complex assignments/projects.

• Works autonomously, only requiring “expert” level technical support from others.

• Reviews, evaluates and executes on new regulatory guidance. Coordinates or leads responses to Member Service related RFPs.

• Identify and integrate data from multiple data sources. Build and/or distribute reports to business partners and clients with a strong focus on efficiency and data quality.

• Produces recurring and ad hoc reports for business partners and clients as assigned. Identify opportunities to automate manual data task and build process improvements.

• Collaborates with cross-functional teams and business partners in defining cadenced, ad hoc or project specific functional requirements.

• Maintain documented inventory of existing reports, routinely testing data validity and responding to inquiries regarding report details. Create and maintain SOPs, job aids and reporting structure inventories.

• Facilitates the intake, triage, root cause analysis, mitigation, impact analysis and closure of all issues associated with regulatory compliance and client satisfaction of Call Center with a particular focus on the Test Call processes executed by CMS, other regulatory agencies and clients.

• Work cross-functionally to support, triage, improve and enhance Interactive Voice Response (IVR) and Automated Outbound Message (AOM) functions as they relate to Regulated Markets lines of business.

• Supports the Product Teams, Operations Teams and Account Teams with function specific communications needs via account team/client inquiry requests, Field Alert development, reporting and presentations.

• Compiles and evaluates data on the functional performance of Call Center. Utilizes in-depth professional knowledge and acumen to develop models and procedures and monitor trends.

• Meet service level standards and respond to partners and customers with patience, empathy and courtesy and high attention to detail.

• Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.

• Coordinates or leads portions of mid-size to large projects. Supports and provides direction to more junior professionals.

• Exhibits proven ability to work cross-functionally in development and execution of operational plans aligned to enterprise goals and in support of the needs of our clients.

• Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives.

• As necessary, follows audit support processes to notify to Express Scripts of client audit needs, facilitate Client/Express Scripts preparation and support for audit scope and document completion of all audit deliverables and findings.

Ideal Candidates will offer:

• Bachelor’s Degree with a preferred focus of Health Care Administration or Business or equivalent experience

• 5+ years experience in a health plan or PBM setting. Medicare, Medicaid and Marketplace experience a plus.

• Knowledge of member services and call center operations systems and processes strongly preferred. Knowledge of IVR and AOM processes a plus.

• Expert level knowledge of Microsoft Excel. Extensive knowledge of other Microsoft Office products (particularly Word, Power Point, etc.).

• Able to balance high priority, long-term projects with short-term, immediate deadlines.

• Creative thinker and exceptional problem-solving skills.

• Ability to follow processes and document information consistently and timely to meet obligations.

• Able to translate technical data concepts to business partners for understanding and alignment.

• Proven ability to function in a heavily matrixed environment.

• Serve as a liaison between Regulated Markets and Call Center Operations

• Experience leading complex projects a plus.

Other Essential Skills:

• Excellent process mapping and analysis skills

• Open communicator; excellent oral and written communication skills

• Ability to work effectively in dynamic, rapidly changing, team-based environment across multiple functions and in support of diverse regulatory obligations.

• Critical thinker and creative problem solver, who exercises good judgment in resolving difficult situations, prioritizes and can balance needs with enterprise objectives.

• Ability to work in a fast-paced deadline-driven environment, and juggle multiple, sometimes competing, priorities and requirements.

• Ability to motivate, influence and connect others.

• Ability to influence direction and action; build and leverage internal relationships.

• Goal oriented and personally accountable; resourceful and self-directed

• Adaptable and flexible; open minded, innovative and creative – seeks ‘out of box’ solutions.

* * * This is a hybrid role that requires the ability to work in person 3 days per week. * * *

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 107,300 - 178,800 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 Group .

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.