Plan Implementation Sr. Analyst - Evernorth - Remote

Summary:

This position is within the National Ancillary Contracting Team. The role involves efficiently managing contract reviews, resolving related issues, and ensuring compliance with all loading instructions, policies, and procedures. It requires proactive identification of process gaps, collaboration across multiple business systems and teams, and support of team training and workload balancing. The position also includes addressing pended claims and providing ongoing feedback to improve operational efficiency and customer satisfaction.

Responsibilities:

• Perform contract reads and work on any fall-out issues from the contracts.
• Understand and follow all loading instruction, policy and procedure documentation. Continually identify and escalate process gaps and opportunities for process efficiencies across documentation to avoid negative customer impacts.
• Loads in HCPM, Facets, Proclaim & PWB.
• Work on our National Ancillary pended claim issues that come from the pended claim team.
• Follow up with the manager on infractions.
• Able to understand the interdependencies between business systems, teams and matrix partners; recognizes when changes or additional analysis needs to be conducted and provide appropriate feedback and suggestions.
• Participate in peer training and coaching support to obtain required processing knowledge.
• Participate in workload balancing daily as needs arise to support work streams and functions.
• Understands needs of the team and supports the team.
• Initiate accurate problem identification and present root cause analysis findings utilizing appropriate data trending tools and resources. Collaborate to implement corrective actions.
• Meet deadlines and accept additional tasks and assignments while maintaining established quality, production, and team timeliness standards.
• Able to work successfully in a team environment.
• Able to work and collaborate with matrix partners to provide regular data performance feedback, close data integrity gaps and proactively seek resolutions.

Qualifications:

Bachelor’s degree or higher strongly preferred or equivalent work experience required.

2 + years of prior work experience with loading provider data required.

Understand how contracts are set up and how current business policies and technology will affect claim payment.

Working knowledge of HCPM, Facets, Proclaim and PWB/CPF required.

Proficiency with Microsoft Word and Access preferred.

Excel experience is required.

Prior claim exposure/experience highly preferred.

Proven ability to maintain positive working relationships, receiving and providing feedback, coaching and guidance to/from other staff members is required.

Self-starter with proven technical, analytical, negotiating, problem-solving, organizational and time management skills. Self-motivated, detail oriented, decisive, and adaptable to change.

Aptitude in demonstrating the ability to maintain a high level of focus and attention to detail while working with complex data and systems.

Ability to function well in a fast-paced, demanding environment.

Must be able to effectively communicate across a wide variety of topics to various audiences.

Ability to work independently while managing multiple tasks and meeting deadlines while also being a strong team player, partnering with others to collaboratively resolve issues and deliver solutions