Legal Compliance Senior Analyst-Cigna Medicare - Part C Monitoring - Part C Appeals (Remote) (Biotech)
Responsible for performing Part C monitoring activities for the Cigna Medicare Compliance Department, with particular emphasis on Part C Appeals. Collaborates with Compliance colleagues and business partners to drive process improvements and ensure successful remediation of identified issues. Forges and maintains positive working relationships with business owners, management, regulators and Compliance colleagues. Demonstrates the ability to influence business partner and/or staff behavior at whatever level and to whatever extent is needed.
To be successful, this candidate must exhibit superior analytical, problem-solving, communication and interpersonal skills, as well as be able to excel in a dynamic, fast-paced environment. The candidate has to demonstrate solid command of the Part C rules, particularly with respect to Part C Appeals. This Compliance team member must be adept at working with a variety of internal and external stakeholders. S/he will promote an enterprise-wide culture of compliance and provide first-rate support within the Compliance Department and across the business units.
• Reports to the Compliance Manager who has responsibility for Appeals on the Part C MBS/Monitoring team;
• Monitors Appeals (internally processed and FDR appeals) to confirm compliance with requirements, including, but not limited to: Direct Member Reimbursements, EOB generation, MOOP calculations, and COVID-19 handling.
• Provides subject matter expertise in response to day-to-day business issues related to appeals and associated functions/processes;
• Collaborates with the Compliance Department's Medicare Business Support Unit and various Business Owners to drive process improvements and ensure that corrective action plans are tailored and appropriate for the deficiencies identified;
• Provides meaningful and appropriate reporting metrics to support the Compliance Monitoring Program;
• Performs other duties as assigned by the Compliance Manager.
• Bachelor's degree preferred;
• Minimum of three to five years of related experience with Medicare Part C regulations and the Medicare Managed Care Manual;
• Strong attention to detail, and analytical skills required; and
• Strong and confident oral and written communication skills
This position is not eligible to be performed in Colorado.
Cigna 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: 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.