Network Operations Senior Analyst Cigna Healthcare Pensacola, Fl Full Time

Job Description

What You’ll Do

CareAllies Provider Engagement Representative is designed for someone early in their career to further develop management skills and provide experience working in a dynamic, flexible work environment. The Provider Engagement Representative role offers:

Roles and Responsibilities

• Serves as primary contact for providers and provider staff to assist in contract management and provide supporting analyses for network and performance optimization. Develops and maintains positive relationships with physicians, providers, and practice managers within the network, including oversight and managing performance in various incentives based and/or value-based programs.
• Provide tactical operations support to assigned groups, including contracting, data integrity, communications, and relationship management.
• Create and deliver materials to educate providers and provider staff on contracts, policies and procedures, quality and service line initiatives, and financial performance.
• Prepares and delivers presentations with providers, provider staff, and/or physician leadership during monthly operational meetings.
• Understands, develops, tracks, monitors and s on key program performance metrics, such as utilization, coding, and STARs/quality performance.
• Perform root cause analyses and resolution related to provider concerns, grievances, claims and care delivery.
• Assist in the STARS and clinical metrics data collection, and design plans for enhanced provider engagement in quality initiatives.
• Prepare materials and participate in monthly financial review with senior leadership.
• Partners with other internal departments, including but not limited to Health Services, Finance, Claims, and Coding in order to develop solutions for strategic business needs.
• Work closely with internal representative for needs and support.

Qualifications

• Bachelor’s Degree Preferred in Healthcare Administration, Business, Finance, Operations, Public Health, or Professional Sales
• Solid understanding of health insurance, customer messaging/design and project management required.
• Excellent communication skills – verbal, written and presentation.
• Experience in public speaking is a plus.
• Intermediate level of Excel preferred (knowledge of pivot tables, VLOOKUP, etc.)
• Experience in financial/trend analysis preferred.
• Team player with proven ability to foster and manage working relationships within a matrix environment to obtain buy-in and drive results.
• Creative thinker with ability to think outside the box and translate ideas into actions.
• Strong problem-solving skills.

Additional Information

• Location: Pensacola, FL
• Requires at least 50% local travel to providers.
• Work Designation: This role is a Flex role, which requires a combination of in-office days, WAH, and field work. Car and Valid Driver’s License is required (mileage reimbursement provided)
• Schedule: Meetings with providers- some night meetings, early morning meetings and occasional weekend conferences.

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 Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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: [email protected] for support. Do not email [email protected] 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.

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