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Appeals and Grievance DirectorThe Government Business Appeals and Grievance (A&G) Director is a leadership role within the Cigna Medicare Customer & Client Service Experience (CCSE) Organization. This role will support the Medicare Advantage and CareAllies lines of business by directly managing the Part C appeals, Part C Grievances, CTM, and Provider Disputes team. The A&G Director will report directly to the Operations Managing Director overseeing CCSE.The primary responsibilities of this role are to ensure that Compliance standards are met or exceeded, and to drive continuous improvement within A&G, and in other functional areas where necessary, to optimize customer experiences. The A&G Director will be responsible for developing and executing an operational strategy for the A&G organization, and for directing day-to-day operations for the Part C Appeals, Grievances, Complaints Tracking Module (CTM), and Provider Disputes teams (Note: add Provider Disputes TBD). In addition, a key responsibility of this role is to review data trends to ensure root causes are corrected to prevent or minimize future occurrences of appeals, grievances, and complaints. This role will require the candidate to engage and motivate a large team of people with diverse skills, responsibilities and geographic locations, and to drive collaboration with matrix partners (e.g. Compliance, Product, Policy, Operations) to understand and deliver upon our commitments to our beneficiaries, providers, and CMS.Responsibilities:
Strengthen and manage connections within the A&G operations team and with key matrix partners including Product Development, Information Technology, Compliance, Market Leadership and Network Operations.
Direct the A&G operations activities for CCSE ensuring compliance with organization and regulatory policies.
Improve quality such that the A&G team consistently meets or exceeds goals for accuracy, timeliness, and regulatory compliance for all department functions.
Routinely assess the talent, knowledge, and performance of the A&G staff and administer necessary coaching, training, and performance management.
Ensure that the A&G team meets all deliverables and milestones related to maintaining an audit readiness position at all times.
Review A&G’s systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals.
Review upstream and downstream systems and processes, recommend improvements to increase efficiency, and sponsor projects and initiatives to achieve optimization goals and to improve customer and provider experiences.
Understand and share business controls and information across CCSE; ensure that there is clear understanding and ownership of key scorecard measurements as well as of total quality measures and initiatives.
Evaluate marketplace opportunities to improve our effectiveness (Cost and Quality).
Utilize information technology tools and techniques for organizing, analyzing and interpreting data to solve specific issues with an initial focus on quality and cost.
Build understanding and awareness of product strategies and assess operational impact readiness to support as applicable.
Implement methods to better utilize customer and provider data to measure our level of success and identify improvement opportunities.
Develop a team of people that can lead the organization into the future, supply future leaders to other parts of the organization, and think differently about how we do business.
Enable a virtual work environment where managers and employees have the tools, resources, and information necessary for teamwork, productivity and engagement.
Qualifications:
BA/BS in Business or related field preferred.
8+ years of large-scale/high volume operations management within the Medicare/Medicaid industry experience required.
Strong knowledge of benefits, claims, appeals, grievances, and Medicare regulatory requirements.
A minimum 5 years of prior direct people management experience with demonstrated results in leading and developing a team of people required. Experience managing a team of managers and virtual management experience strongly preferred.
Innovative, strategic and creative thinking skills with a focus on continuous process improvement is required.
Highly collaborative individual with the ability to drive change and influence within a cross-functional matrix team environment. Strong communication skills; written, oral and listening skills.
Location & Travel : Nashville (preferred) or Work from Home; Up to 20% travel required.About CignaCigna 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 an accommodation based on your physical or mental disability please email: [email protected]. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
Vacancy caducado!