Position SummaryThis Financial Analysis Advisor position will provide support to the Centene account.Specifically, the responsibilities of the role will include:
Provides advanced professional input on DOI complaints with Centene client focus.
Reviews and provides determination of pharmacy appeals.
Communicates externally to pharmacies and clients, providing professional responses to inquires and appeals.
Responsible for conducting moderate to complex compliance analysis, projects and/or reporting.
Assist in development and QA of reports and recommend improvements in compliance reporting systems.
May conduct audits to ensure data controls are maintained.
May design, enhance and maintain system applications for processing and reporting compliance information
Essential Functions
Extract, analyze, validate, and communicate intelligence from large sets of data
Supports and develops compliance monitoring
Develop new analytic resources and views of data from in-depth analysis and understanding
Assist with internal and external audit request
Develop, help maintain, and troubleshoot complex internal MS Excel spreadsheets, SQL coding and R coding scripts
Assists with Ad-Hoc requests
Reviews and replies to pharmacy appeals, DOI requests and pharmacy emails
Qualifications
Bachelor's Degree in Finance, Accounting or related field preferred, MBA a plus.
At least 4 years in a finance, accounting or highly analytical position
Experience in healthcare / insurance industry preferred
Technical knowledge of relational database concepts, querying, data warehouses and decision support tools, including but not limited to: SQL, Excel, and R
Ability to utilize independent judgment and discretion, identify variances, and recommend solutions
Experience in a highly regulated business environment
Ability to communicate results of analytics to a multitude of individuals/groups
Strong analytical and problem-solving skills
A self-motivated team player who thrives on challenges, is comfortable working in a fast-paced, dynamic environment, and is ready for development within our Company
Innovative and strong desire to learn
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.About Evernorth Health ServicesEvernorth 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.
