Operations Lead Analyst-Medicare Part D (work from home) - #100642


Date: 04/20/2022 00:30 AM

City: Bloomfield, Connecticut

Contract type: Full Time

Work schedule: Full Day

Job Location: Hartford, CT or work from home, remote, United States

The Operations Lead Analyst Medicare Part D will be accountable to support oversight and monitoring of individual Prescription Drug Plan (PDP) Enrollment & Premium Billing operations, compliance with CMS (Centers for Medicare & Medicaid Services) requirements, mock audit support and CMS plan audits support. Oversight of Enrollment and Premium Billing operations to identify non-adherence to established processes as well as identify improvement opportunities. Report results through ongoing audit spreadsheets, dashboards and scorecards. This role includes vendor oversight & collaboration and coordination with other internal partners and other lines of business for consistent processes across operations.


Support daily oversight and monitoring of PDP Enrollment & Premium Billing operations with the vendor, internal and external partners. Includes BPO vendor, Pharmacy Claim vendor (Express Scripts), and internal Cigna Government Business & matrix partners

Perform ongoing review and interpretation of new and existing CMS requirements to ensure processes are compliant with CMS.

Monitor operational metrics, critical volumes, and daily inventory to proactively identify potential issues.

Review Service Level Agreement (SLA) on a monthly basis and work with vendor/matrix partners to address any issues impacting enrollment and billing operations

Manage weekly monitoring activities; pulling samples, tracking results and evidence of corrective action to support CPE audits, and prepare results reporting for leadership.

Perform focused monitoring/audits post deployment of changes to operational processes.

Participate in and actively support all internal, external, and CMS audit activities by quality reviewing universes, samples and all supporting documentation.

Identify and articulate trends and issues found in monitoring and work with business partners and vendor for remediation and/or process improvements.

Support additional duties and projects based on business needs such as AEP and 1/1 Readiness activities related to enrollment and billing.

Support Annual review of vendor policy & procedures to ensure processes are up to date and current with CMS guidance and Company Business policies.

Required Qualifications:

Bachelor's degree or equivalent work experience

3-4 years of relevant Medicare (Part D and/or Part C) or other government program experience in eligibility, premium billing or healthcare operations highly preferred

Proficiency with Microsoft Word, Excel, Outlook, PowerPoint

Previous auditing experience preferred

Excellent conceptual and analytical skills, ability to: identify linkage between interfacing systems and processes, identify issues and to manage/execute solutions to resolution

Ability to perform responsibilities independently as well as an effective team member

Able to analyze situations and is comfortable dealing with ambiguity while remaining detail oriented

Ability to learn process and product information quickly and efficiently.

Must be self-motivated and possess the competencies required to work in a fast-paced and heavily matrixed environment

Excellent organizational and written/verbal communication skills

Self-Learner, independent strategic and creative thinker

Exposure to auditing methodology and process a plus

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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.

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