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Summary:

Lead and develop extremely talented and cross functional team responsible for day-to-day Maximum Allowable Cost (MAC) and pharmacy appeal regulations. Responsible for leading team that oversees State and Federal pharmacy reimbursement legislation and pharmacy appeals. Oversee business regulatory compliance projects and process enhancements. Monitor pharmacy reimbursement compliance, solve complex problems and propose solutions. Support new legislation and serve as a subject matter expert (SME) pertaining to State and Federal pricing, client specialty pricing, and pharmacy appeals. Responsible for providing Ad Hoc training, support and financial analysis of impacted areas for a variety of audiences and departments.

Responsibilities:

+ Lead and develop team responsible for pharmacy appeals, secondary appeals, and department of insurance complaints.

+ Support talented team in day-to-day tasks that involve State and Federal regulatory compliance, working cross functionally with other departments both internal and external.

+ Lead team in the setting up of specialized client pharmacy pricing, including regulated markets business.

+ Support new business project opportunities and process improvements.

+ Lead and assist team through ad hoc projects and complex data analysis.

Qualifications:

+ Bachelor’s degree in finance or related highly desired.

+ At least 4 - 5 years plus of business experience in PBM or advanced Pharmacy setting

+ At least 1 year plus of leadership & regulatory compliance experience is preferred.

+ Experience with all MS Office applications. Teradata and SQL experience preferred, but not required

+ Excellent quantitative skills and ability to perform advanced problem solving.

+ Analytical, highly organized, able to work with little supervision, motivated to successfully meet deadlines, attention to detail and ability to multi-task.

+ Ability to work collaboratively with multiple departments

+ Excellent Communication skills, oral and written.

+ Will consider hiring a remote employee if qualified

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 Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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._

_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._