Develop network capability strategy, ranging from new to market-tested concepts, with in-depth research and understanding of local and global availability and capability heat map.
Develop roadmap and implementation plan; outlining objectives, requirements, risks, data, technology, process, and external needs from ideation to execution.
Create and manage up-to-date Network intelligence playbooks and library, reflecting global and local best practices, (including that of US – a plus)
Identify, create, test, and drive new network service scope opportunities to delivery. Examples include: mental health vertical, shared risk/reward models, bundle payment, key country cost-charge information, cashless network, virtual care, medical transportation, wrap-around services, steerage, etc.
Synthesis and articulate the important levers of customer and provider behavior incentives (and its precursors and risks) that impact the success of COE programs.
Work with regional network teams and cross-functional business partners for COE project delivery.
Identify and promote improvement (process and/or cost) opportunities with TPAs and other Cigna partnerships; can be as part of standard COE program for broader reach.
Accountable for medical cost efficiency improvement targets as a result of implementing COE programs.
Perform local and global cos and program analytics to validate assumptions in developing business case for COE program development.
Identify payment integrity, FWA, and cost containment opportunities and best practices to develop as Payment Integrity COE asset that are scalable and can be deployed as product/payer agnostic solutions.
Develop and conduct Network intelligence and COE program training sessions.
Effectively communicates and interacts with other business units to achieve goals; e.g. Medical Management, CIGNA Service Operations (NA, UK and Antwerp), Sales and Client Management (NA, UK, and Antwerp), and CIGNA Strategy & Operations.
University degree, Master Degree preferred.
7+ years of relevant experience.
Proven experience and success track record of understanding provider billing practices and reimbursement methodologies, and having worked with providers and/or healthcare systems in designing network other than traditional FFS or open network. (example: value based care)
Innovative and know how to translate ideas to action with sufficient data and market based insight.
In-depth understanding of health plan operations and provider contracts.
Change management experience.
Experience establishing and / or managing high performing TPA relationships a plus
Experience with running pilots and audits a plus.
Knowledge of health plans product benefit designs and other medical cost management levers
Excellent interpersonal, communication and motivational skills, including negotiation and presentation skills.
Strong influencing skills and ability to work in a complex, highly matrixed, environment, including balancing priorities of multiple organizations to deliver end results.
Strong people management and development skills.
Effective problem resolution skills.
Above average data analytics competency.
Proficiency with MS Office programs including: Word, PowerPoint, Excel, Project, and Visio.
Personal Competencies Required:
Strategic and critical-thinking skills.
Strong conflict resolution and people management skills.
Ability to take charge and make sound business decisions.
Ability to organize and manage complex initiatives.
Results-oriented, out-of-the-box, problem solver.
Excellent interpersonal, verbal, and written communication skills.
English and other languages a plus.
Mature, with the ability to effectively communicate and influence individuals at all levels.
Comfortable working in a fast paced environment with shifting priorities.
Energetic and enthusiastic.
A team player.
Ability to flex up to strategic level and down to running program management tasks.
Willing to travel regularly (up to 15%).
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
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.