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Operations Risk Lead Analyst

3 months ago


Mississauga, Ontario, Canada The Cigna Group Full time

Description:

Key Responsibilities:

Produce financial reports for clients and provide insights into trends

Responsible for provider electronic withhold entries for audit recoveries for all benefits

Monitor electronic withhold to satisfy timely audit recoveries

Conduct quality review of audit reports for administrative accuracy and adherence to policies and timely submission to clients

Review claim selections to ensure adherence to program guidelines.

Collect and analyze quality assurance data for public sector client meetings and internal metrics

Lead audit report review meetings with clients and prepare meeting minutes

Ensure alignment and consistency of delivery of program between all benefits

Identify emerging trends and create presentations for clients to support audit result meetings

Work with both internal and external stakeholders to address client inquiries, gather, collect information, for deliverables

Conduct monthly quality assurance review of staff time trackers

Create and maintain forecasting tools for oversight on key performance indicators and emerging trends

Oversee program training documents, SOPs, and working instructions. Ensure processes are mapped out, outlined and organized for team to utilize

Lead quality-focused remedial training sessions for team. Assist managers with maintaining training records

Identify, lead and manage special projects and program initiatives

Continuously seek opportunities to create efficiencies within processes and drive value for the program

Resolve non-routine issues escalated from other team members. Mentoring and developing team members using agile concepts.

Tasks involve a degree of forward planning and anticipation of needs/issues

Other duties as assigned

Qualifications:

Bachelor's degree or equivalent work experience

Minimum of 4 years of related experience in Pharmacy and/or Dental Benefit Management, Group Insurance or Health Care Operations

Experience with compiling, manipulating or validating large pieces of data

Ability to maintain electronic filing systems

Display high levels of curiosity, integrity, tact and objective judgement

Excellent organizational, planning and critical thinking skills

Excellent verbal and written communication skills, including ability to present to clients and internal stakeholders

Proven interpersonal skills and ability to work well with senior management and high-level external contacts handling sensitive or confidential information is critical

Ability to work with minimum management oversight on multiple projects with competing priorities

Ability to work a flexible schedule in high pressure environments with urgent deadlines

Proven time and resource management skills; detail oriented with strong organizational abilities.

Express Scripts Canada is a Cigna company
Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company

Cigna Corporation (NYSE:
CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve.

Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada
Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment.

We provide Active Pharmacy services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually.

Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.


We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.

We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace.

By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.


We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.