Product Management Analyst

Job Summary : The Product Management Analyst is a member of the enrollment & eligibility organization that is responsible for assisting in reconciling enrollment issues for prospective members who enroll into the Medicare Part D Plan, but encountered enrollment processing concerns in regards to the enrollment process, due to incomplete applications. The Product Management Analyst will work closely with in-house departments, vendors and the client to address enrollment related issues and other inquiries regarding patient membership status. The Product Management Analyst has cross functional duties that involve recording information when prescribers respond to plan questionnaires as it relates to Part A and Part B claims. In addition to preparing packets for backend scanning. Responsibilities:

• Work with administrative services to resolve enrollment issues.
• Make updates to member Personal Health Information and other enrollment related information.
• Confirmation of CMS eligibility records. MARx system is used for verification of: Part A, B, and D eligibility status and effective dates, Low Income Subsidy (LIS) status, Hospice status, Late Enrollment Penalty (LEP) status, Health Insurance Claim Number, and residence address.
• Use enrollment vendor system to submit routes to the vendor requesting retroactive enrollment, cancellation, or disenrollment.
• Will send requests to the enrollment vendor for group updates, effective date changes, and out of area requests.
• Will receive requests to verify enrollment effective dates with the client, when an invalid effective date is submitted.
• Use the Facets database to verify enrollment records.
• Work with clients and vendors to research and process category 3 requests.
• Interface with the PBM regarding any and all escalated prescription issues including claims processing, order delays, payment posting, triaging with pharmacy partners, retail network pharmacy issues, direct claims, and customer service opportunities.
• Record prescriber responses from incoming mail
• Assist with other duties as it relates to ESRD Hospice retrospective claim billing concerns and patient file information.

Qualifications:

• HS Diploma or GED required/Bachelor's degree preferred.
• 4 years' experience in a customer service/data entry setting; preferably experience in the Medicare or Healthcare Industry.
• Excellent eligibility system knowledge; Proficient in Microsoft applications - MS Word, Excel, Access and PowerPoint.
• Excellent phone skills.
• Ability to work cross-functionally to resolve complex client issues.
• Strong organizational skills.
• Ability to manage timelines and balance multiple deadlines.
• Ability to work a flexible schedule.
• Demonstrated ability to handle internal and external customers in a professional manner.
• Ability to adapt in a dynamic work environment, learn quickly, solve problems and make decisions.
• Ability to navigate through multiple systems simultaneously.
• Ability to act as a company ambassador when interfacing with clients to positively represent ESI's vision, values, and client pledge.

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: for support. Do not email 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.