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Product Management Senior Advisor, Claims Transactions and Adjustments - Express Scripts - Hybrid

Product Management Senior Advisor, Claims Transactions and Adjustments - Express Scripts - Hybrid

Missouri StaffingSaint Louis, MO, US
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Product Management Senior Advisor

The Product Management Senior Advisor is responsible for supporting Claim and Adjustment data that is provided to our clients. To help educate clients on methods of delivery, interpreting the data, and best practices for using the data within their systems. The position will also support internal stakeholders and account teams as a subject matter expert on claim and adjustment data. This position will ensure responsibility in establishing a working partnership and process flow between the client, account management, and data analytics team(s). Support on client calls providing overview of the processes, expectations, education, and answering client questions as needed.

Position Details :

  • Serve as the Regulated Markets business owner for Claim and Adjustment data that is provided to our clients.
  • Meet with account teams and clients, educating how data claim and adjustment data is provided and how to understand and use the data.
  • Understanding project changes due to new or changing regulations and the impact to data and files provided internally and to clients.
  • Establishing a working partnership and process flow between the client, account management, and data analytics team(s).
  • Responsible for gathering business requirements and define alignment on functional requirements and rules.
  • Analyze trends and data to develop recommendations to ensure client needs, compliance metrics, and / or internal support is 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.
  • Ability to appropriately interact with clients / account teams including :
  • Communicate information about their area of expertise.
  • Meet with clients to educate and also help troubleshoot concerns.
  • Manage account team expectations and ensure appropriate follow-up.

Qualifications :

  • College degree or equivalent experience preferred.
  • 5 or more years 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 required.
  • High attention to detail and proven ability to manage multiple, competing priorities simultaneously.
  • Internal and External Customer focused in all activities.
  • Excels working cross functionally, at all levels of the organization to own, drive, manage, and continuously improve the processes, perform root cause analysis, and develop reporting, and communication processes.
  • Knowledge of PBM / healthcare industry or specialized business area.
  • Ability to see business needs outside of one's own work area.
  • Ability to execute tactics under a strategic vision.
  • SQL skills are highly desirable.

    • 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 110,700 - 184,500 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.

    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.

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    Product Management • Saint Louis, MO, US