• Responsável por elaborar e manter atualizada a estratégia de teste do sistema, construir os artefatos necessários para execução dos testes, manter os scripts e artefatos de testes atualizados, acompanhar o desenvolvimento das demandas desde a sua concepção. • Manter em execução toda a estrutura que compõe os testes dos sistemas envolvidos, tais como, massa, scripts, artefatos, simuladores, rotinas e processos negociais dos sistemas; • Realizar a gestão e planejamento de testes, com capacidade para geração de documentação básica de testes como estratégia, planos, casos e scripts de testes etc.; • Criar scripts em ferramentas específicas, automatizados e não automatizados, bem como executá-los registrando e analisando os resultados; • Executar testes de aceitação, compatibilidade, regressão, integração, funcionais e não funcionais (exploratórios, conectividade, vulnerabilidade, estresse e carga) de acordo com a necessidade de cada demanda (conforme análise de impacto ou necessidade definida pelo cliente); • Construir mocks, stubs e/ou simuladores a fim de viabilizar a execução de testes; • Avaliar os requisitos não-funcionais de desempenho de um sistema através do uso de ferramentas específicas e monitores; • Monitorar e acompanhar os níveis de cobertura de testes dos sistemas promovendo o aumento da cobertura sempre que necessário; • Registrar os erros encontrados após à execução dos testes, relacionando aos produtos de trabalho pertinentes; • Avaliar o resultado de cada ciclo de teste; • Apoiar gestores e equipes responsáveis na homologação de demandas dos sistemas; • Criar testes baseados em cenários de negócio, modelar testes baseados na experiência e em defeitos; • Compreender o funcionamento dos sistemas em teste; • Elaborar cenários de testes de software e identificar falhas e erros comuns em softwares; • Compreender negócio, requisitos, programação e testes para atuar como co-responsável por todo ciclo de desenvolvimento; • Realizar ATDD, BDD e/ou Specification by Example; • Realizar a manutenção dos ciclos dos sistemas (homologação ativa) em ambientes definidos, com rotinas diárias, mensais, batch e interfaces; • Planejar/executar testes para alinhar o escopo da disciplina ao prazo disponível; • Avaliar os aspectos mais comuns de segurança indicados pelo organismo OWASP (https://www.owasp.org/); • Utilizar ferramentas especializadas em automatização, performance e planejamento, gerenciamento e execução de testes; • Criar scripts nas ferramentas especialistas, bem como trabalhar com execução automatizada com massa de dados variável (datapool); • Realizar a manutenção dos ciclos dos sistemas em ambiente de laboratório do cliente, bem como de rotinas diárias, mensais, batch e interfaces; • Identificar vulnerabilidades de segurança e propor melhorias nos sistemas. • Responsável pelo desenvolvimento, acompanhamento e evolução de Produtos Minimamente Viáveis (MVP), incluindo o experimento com o usuário final ou grupo de teste, controle e monitoramento dos resultados; • Atuar na definição, controle e reporte de indicadores de desempenho para inovações/novos produtos; • Articular ações entre equipes multidisciplinares, com foco em resultados a curto, médio e longo prazo; • Atuar junto a parceiros, definindo, priorizando e orientando sobre soluções e cronogramas.

Job Title & Specialty Area: Lead Analyst, Managed Care Contracting Department: Managed Care Location: Dallas, Texas (Must be a Texas Resident) Shift: Full-Time Monday - Friday Job Type: Remote Why Children's Health? At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal. Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being. Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all. Summary: *This is an ANALYTICAL role focused on financial and contract modeling and data analysis - NOT contract negotiation, Revenue Cycle operations, or PFS Responsibilities include complex data and financial analysis, financial interpretation of contract terms, contract modeling, , data validation, developing reimbursement methodologies, maintaining contracts in EPIC and identification of revenue enhancing opportunities. Develop alternative financial proposals that are within the budget parameters, based on analysis and modeling of contract performance by developing and preparing revised models using sound rationale, and present recommendations to Managed Care leadership. Support the organization by providing ad-hoc detailed data reports related to Managed Care agreements and Patient Financial Services activity to internal and external customers. Responsibilities: * Collaborate with other departments to prioritize and ensure Managed Care contract performance and all related analytic needs are met for the system. Serve as a mentor to other Analysts on the team and a subject matter expert to other CHST departments. * Complete financial impact analysis of all contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Present analysis and recommendations to leadership. * Prepare multiple analyses and presentations by extracting data from systems including Crystal, EPIC, STRATA and other Children's Health Services of Texas (CHST) systems and relational databases utilizing expertise in Excel. Evaluates the need to create new or modify existing ad hoc and/or customized reports. * Review all Managed Care contracts and amendments as received and complete require system updates, ensuring that all contracts in EPIC are current and calculating correctly. * Analyze contracts and prepare all supporting schedules necessary to update/maintain the EPIC system on a current basis. This includes but not limited to: reviewing all new contracts/amendments, meeting with Revenue Cycle staff to review changes, communicating with the payors to receive all updates on current basis, researching and downloading data form payor sites, analyzing and comparing new fee schedules to the prior fee schedules, preparing all uploads, validating input and updating EPIC reimbursement contracts. * Stay abreast of all Texas Medicaid & Healthcare Partnership (TMHP), CMS and other governmental regulation changes that affect Fee Schedule pricing. Proactively model all changes to fee schedules to determine the financial impact on CHST revenue and communicate with leadership. * Accountable for the maintenance of the Payor and Plan database in EPIC. Facilitate monthly meetings and seek agreement before any changes are made. Maintain the synchronization among the service areas. Ensure all plans are mapped to correct contract in EPIC and facilitate audits, at least on a quarterly basis. * Interprets managed care contract terms and validates understanding with the contract negotiator and model relevant parameters into contract model application for contracts with annual revenue in excess of $2.3 Billion. * Accountable for contract model module and/or application, including but not limited to the maintenance of commercial and government Managed Care Organization (MCO) contracts, fee schedules and other tables relating to contract modeling generating annual CHST revenue of in excess of $1.5 Billion. * Actively participates on cross functional teams to identify revenue enhancement opportunities and develop and implement solutions for under-performing facility and professional contracts, including improvements in denials and underpayments. Provides necessary reporting and analytics to support the goals of these teams. * Communicates difficult and/or sensitive and confidential information. Handles confidential material on a regular basis and is responsible for protecting the confidentiality of such information within the established guidelines of CHST and law. * Supports the Senior Director, Managed Care with existing and new projects/initiatives. * Works in a fast-paced environment with frequently changing priorities. WORK EXPERIENCE * At least 5 years experience in financial analysis, data mining and reporting Required * At least 5 years experience with hospital billing system, EPIC Preferred * At least 5 years experience in Healthcare, contract modeling and analysis for facility and professional agreements Preferred EDUCATION * Four-year Bachelor's degree or equivalent experience Required LICENSES AND CERTIFICATIONS * Epic certification within one year of hire 1 Year Required A Place Where You Belong We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children’s Health a place where everyone can contribute. Holistic Benefits – How We’ll Care for You: · Employee portion of medical plan premiums are covered after 3 years. · 4%-10% employee savings plan match based on tenure · Paid Parental Leave (up to 12 weeks) · Caregiver Leave · Adoption and surrogacy reimbursement As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.

The job profile for this position is Operations Lead Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. The responsibilities of an Operations Lead Analyst include monitoring daily request execution, reporting, and issue triaging for one or more owned client(s) upon request. Identifying operational or productivity enhancements, barriers, and opportunities for configuration and workflows. The Operations Lead Analyst will provide project and administrative support to leadership teams or Operations Advisors through escalation of issues, risks, and concerns as needed. Provides support to assigned projects by responding to inquiries or resolving complex issues using independent judgment, discretion, and general client knowledge. Routine communication of risk and status of owned clients and processes to leadership teams. What you'll do to make a difference: - Executes client requests and inquiries in alignment with SLAs and other contractual terms. - Monitors and triages client issues in alignment with SLAs and other contractual terms. - Adheres to all organizational SOPs and Compliance standards and provides subject matter input related to checklists and SOPs. - Assists with operational input related to new process development, including identification, research, and resolution of operational issues, and provides training and mentoring for new team members, offshore, and contingent employee resources. - Complies with ESI document and retention requirements. - Provides exceptional service to clients. - Collaborates cross-functionally and communicates effectively with necessary internal partners. - Communicates issues and status clearly and timely to leadership teams. - Maintains working relationships through collaboration with Account Management and clients for requirements intake and issue resolution; IT for system issues, setup, and testing; Product Teams to coordinate setup and resolve issues; Quality Teams for issue resolution and documentation; and Leadership Teams for initiative engagements and client health updates. What you need to be successful: - High School Diploma or GED required. Bachelor's degree preferred. - 3+ years of relevant experience required. - Strong knowledge of the healthcare and PBM industry and its products and services highly preferred. - Detail-oriented with strong analytical and problem-solving skills. - Ability to manage timelines and meet tight deadlines. - Ability to adapt in a dynamic work environment and make independent decisions. - Good organizational and prioritization skills with the ability to multitask. - Demonstrated ability to work with other departments and teams to resolve issues. - Experience with the use of ERP systems. - Proficient computer skills including all Microsoft office applications required. - Experience with data input and reconciliation. 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. For this position, we anticipate offering an annual salary of 62,600 - 104,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. 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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

This role supports the Pricing & Eligibility team by helping ensure contract pricing data is accurate, customer eligibility is properly determined, and pricing and membership work is completed in line with vendor requirements and department timelines. The person in this role uses strong attention to detail, problem-solving ability, and communication skills to support pricing accuracy, audit readiness, and service for internal and external partners. Key Responsibilities - Review and validate credit and rebill requests for completeness and accuracy. - Provide customer service related to pricing and membership for internal and external partners. - Capture and maintain required audit documentation. - Determine appropriate member access to contract pricing based on required customer criteria. - Review and complete assigned work in the queue according to department guidelines. - Research supplier and customer pricing and membership claims and take corrective action as needed within established timelines. - Escalate issues to management in a timely manner. - Work collaboratively on projects to identify solutions and process improvements. Requirements - High school diploma or equivalent. - Minimum of 3 years of experience in a business-to-business manufacturing or distribution environment. - Strong analytical and problem-solving skills. - Experience analyzing data. - Strong data entry skills. - Experience using modern ERP software, including SAP and/or Oracle. - Excellent verbal and written communication skills. - Ability to manage timelines and meet vendor-specific deadlines. - Ability to multitask in a fast-paced environment where accuracy is critical. Preferred Qualifications - Some college. - Pricing and membership eligibility experience. - Knowledge of Microsoft Office products, including intermediate Excel skills. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.