Product Management Senior Analyst - Express Scripts - Hybrid

Role Summary

The Regulated Markets Services team is responsible for ensuring the execution of key operations accountabilities associated with all regulated lines of business including Medicare, Medicaid, and Marketplace (Exchange / Health Care Reform).

The team supports Pharmacy Benefit Management (PBM) delegated responsibilities associated with Call Center and Grievances oversight, regulatory audit support, issue management and analytics.

The Senior Analysts' primary role will be to support the Grievance functions as it relates to the Medicare, Medicaid and Marketplace (Exchange / Healthcare Reform) initiatives to ensure member/client and internal satisfaction and alignment with both regulatory and client contractual support.

When necessary the analyst will also provide functional SME support to client facing discussions.

Responsibilities:


* Provides highly proficient professional input to complex assignments/projects.


* Facilitates the intake, triage, root cause analysis, mitigation, impact analysis and closure of all client and audit issues associated with regulatory compliance of Grievances.


* Reviews, evaluates and executes on new regulatory guidance.


* Promotes the tracking and documentation of all team activities in associated systems.


* Supports the Product Teams, Operations Teams and Account Teams with function specific communications needs via account team/client inquiry requests, Field Alert development, deliverable reports and presentations.


* Build and distribute recurring and ad hoc reports for business partners and clients as assigned.

Identify and integrate data from multiple data sources.

Identify opportunities to automate manual data tasks and build process improvements.


* Maintain documented inventory of existing reports, routinely testing data validity and responding to inquiries regarding report details.

Create and maintain SOPs, job aids and reporting structure inventories.


* Participates as SME in client meetings regarding grievance processes.


* Coordinates or leads responses to Grievance RFPs


* Collaborates with Grievance and Call Center Operations teams to oversee the grievance process, identify and remediate trends and problems and develop and deploy creative solutions to improve efficiency, compliance and member satisfaction.


* Develops and deploys oversight and surveillance processes for Health Plan grievances.


* Acts as Business Owner for development and enhancement of grievance processes.

Collaborates with Technical Product Owner to develop business requirements.


* Coordinate or lead portions of mid-size projects.

Supports and provides direction to more junior professionals.



* Contributes to audit support processes for client program, data validation, oversight and operational audit needs, facilitate Client/Express Scripts preparation and support for audit scope and document completion of all audit deliverables and findings

Ideal Candidates...