Medicare/Medicaid Pharmacy – Benefit Lead Analyst


Job Location: Remote, United States, Work from home. Position Summary: This position is responsible for jointly building annual Medicare/Medicaid Pharmacy Benefits and assist with performing annual readiness claim testing (inclusive of writing and running testing scripts) with Cigna’s Medicare and Medicaid internal Pharmacy Operations teams and our Pharmacy Benefit Manager-Express Scripts (ESI).The primary focus is on Cigna – Medicare and Medicaid Pharmacy Benefit Readiness for January 1st. For 1/1/ readiness, it would include PBM (ESI) Structure and Benefit Configuration builds, benefit validations, and some testing for claim accuracy. It may also include testing for off 1/1 ESI system and Cigna Pharmacy systems scheduled releases.Throughout the year, this person will assist with ongoing Pharmacy general readiness as a response to Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Federal, State regulatory mandates.This position also plays an active role in the 1/1 Go Live – Day One Pharmacy business check outs with other internal operational teams and by performing triage and benefit research of possible claim processing issues. Primary Responsibilities :Build and maintain Pharmacy Benefit Grids for all Medicare and Medicaid Products – inclusive of both Medicare Individual and Employer product offerings.Create and maintain account structure as needed to support production expansion and complex benefit setup requirements.Coordinate structure changes with various matrix partners to ensure seamless end to end data flow between systems.Partner with IT to bridge process gaps and continuously enhance benefit automation capabilities.Perform Pharmacy Benefit Validations as assigned.Assist with providing consultations for benefit and formulary designs, benefit build process, as needed in support of any Medicare or Medicaid Pharmacy functional team (i.e. Clinical, Regulatory, Eligibility, etc.)Assist with creation and managing of the Pharmacy Benefit and Testing section of the joint Cigna-ESI Op Annual Readiness Project Plan by performing, tracking, and reporting on assigned tasksMay assist with writing and performing Medicare- Medicaid Pharmacy Benefit, Formulary and Claim processing test scripts as assignedAssist or lead facilitation of joint integrated meetings associated with pre 1/1 Readiness benefit and testing issues or post 1/1 benefit issues with Pharmacy Benefit Manager (ESI), and other internal Pharmacy functional teams such as Product, Clinical, Compliance and Government Business Operational Teams.Lead or assist with re-design and updates of documented Pharmacy benefit build and testing processes, training and job aid materials – as needed for Operational Readiness or as assigned by managerAssist various Medicare-Medicaid Pharmacy Ops Teams with performing claim tests, researching and resolving complex benefit and claim processing issues, as assigned.Compile required benefit and testing documentation for audits as needed or assigned. Qualifications :PLEASE NOTE- YOU MUST HAVE PREVIOUS HEALTHCARE OR HEALTHPLAN EXPERIENCE TO BE CONSIDEREDAssociate or Bachelor’s degree in Business, or relevant work experience in Medicare/Medicaid or Commercial Pharmacy Benefits design and Claim processing preferredPrevious Healthcare or Health Plan experience requiredIntermediate experience with Excel required 2+ years relevant experience within Pharmacy Benefits, Formulary or a Pharmacy Claim environment preferredFormulary Knowledge (Meds, Quantity Limits, Days Supply, Dosing) or Pharmacy Tech experience preferredSystem or Business Testing experience helpfulExperience with building or adhering to defined work plans and aggressive timelines – requiredExperience working with Regulatory/Compliance – Federal and State preferredHigh degree of organization and time management and productivity skills – requiredThis position is not eligible to be performed in Colorado.About CignaCigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, 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 Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.


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