Account Management (Non-IC) Senior Associate- Hybrid - Express Scripts (Finance)

The Clinical Associate Account Manager (AAM) serves as the primary liaison between the client and internal clinical operations teams, ensuring the accurate implementation and validation of pharmacy benefit designs and utilization management criteria. This client-embedded role is responsible for triaging and resolving clinical testing issues, interpreting regulatory and policy requirements, and driving cross-functional collaboration to support compliant, high-quality member experiences. The AAM plays a critical role in identifying systemic issues, escalating high-severity defects, and delivering insights that inform continuous improvement across clinical testing and benefit configuration processes.

• Serve as the primary clinical testing liaison for the designated client-triaging inbound questions, clarifying clinical test requirements, and driving rapid issue resolution.
• Proactively communicate clinical testing timelines, results, and remediation plans to client stakeholders; clarify benefit impacts of any clinical logic changes.
• Track daily defect tickets, test-case queues, and clinical inquiry volumes; rebalance work to maintain turnaround.
• Act as the escalation point for high-severity test defects or urgent OCEP policy questions, coordinating with Clinical Ops, IT, and Compliance to deliver root-cause fixes.
• Exercise clinical judgment to interpret PDL/UM criteria, state-specific regulations, and OCEP guidelines when recommending resolutions for complex test failures.
• Analyze test results to identify recurring clinical logic gaps, data integrity risks, and policy-compliance trends; feed insights into quarterly OCEP maintenance plans.
• Partner with ClinOps, Configuration, Pharmacy & Therapeutics, and Regulatory teams to research clinical edits and confirm accurate implementation across environments.
• Serve as subject-matter expert on the end-to-end Clinical Testing Playbook, including scenario design, benefit set up, and documentation standards.
• Lead cross-functional test-readiness huddles to ensure smooth deployment of clinical changes with minimal operational risk.
• Deliver concise clinical test-status readouts and risk dashboards to client leadership and internal governance forums.
• Function as the single point of contact for the client's clinical test workstream-post-production validation and maintenance.

Qualifications

• Bachelor's degree in a healthcare, life sciences, or related field; or 3+ years of experience in clinical operations, pharmacy benefit management (PBM), or healthcare account management.

• Minimum 3 years of experience in a client-facing or healthcare service role, with demonstrated ability to manage escalations and resolve complex clinical or operational issues.
• Working knowledge of formulary management, prior authorization criteria, and regulatory frameworks (e.g., CMS, Medicaid, OCEP).
• Strong analytical and critical thinking skills, with the ability to interpret clinical test results and identify root causes of benefit logic discrepancies.
• Excellent verbal and written communication skills, including the ability to present clinical findings and project updates to both technical and non-technical stakeholders.
• Proficiency in Microsoft Office tools; experience with Excel, Access and clinical testing platforms preferred.
• Ability to work independently in a fast-paced, dynamic environment and collaborate effectively across cross-functional teams.
• Willingness to travel up to 10% as needed.

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.