Product Management Lead Analyst - Express Scripts

Product Management Lead Analyst - Centene Operations Management

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The Regulated Markets Centene Operations Management 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 regulatory requests (including audit support), issue management, adjustment processing, and regulatory communications.

The Lead Analyst will support initiatives to ensure member/client satisfaction, alignment with client contractual support and client retention.

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

Key Responsibilities:


* Provides advanced professional input to complex assignments/projects.


* Works autonomously, only requiring "expert" level technical support from others.


* Partners with internal Audit teams to notify Express Scripts of client audit needs, facilitate Client/Express Scripts preparation and support for audit scope and document completion of all audit deliverables and findings for all Medicare (CMS Program Audit, Data Validation, Acumen), Medicaid (Readiness Reviews, External Quality Review Organization (EQRO), Financial, Credentialing, Quality of Care) Marketplace (Market Conduct Exams, Quality of Care) audit types.


* Coordinates with subject matter experts to deliver response on all regulatory contract assessments, policy verifications, requests for information (RFI), and general inquiries for client's book of business.


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


* Process completion of all adjustment requests aligned with client specific request processes.


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


* Supports the client Project Management Office (PMO) and Account Teams with function specific communications needs via account team/client inquiry, including deliverable reports and presentations.


* Compiles and evaluates data on the functional performance.

Utilizes in-depth professional knowledge and acumen to develop models and procedures and monitor trends.


* Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures.


* May assist, coordinate or lead portions of mid-size projects.

Supports and provides direction to more junior professionals.



* Exhibits proven ability to work cross-functi...