- Act as Subject Matter Expert for the eviCore claim systems and related job processes
- Completes day-to-day project tasks without immediate supervision
- Responsible for prioritization and execution of assigned tasks and ability to identify needed actions with limited direction.
- Tasks involve a degree of forward planning and anticipation of needs/issues
- Responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments
- Lead discussions with cross-functional teams, to understand, document and evaluate processes for opportunities to continually improve automation and accuracy
- Research and resolve and/or track resolution status for non-routine issues escalated from leadership, business, clients and junior team members
- Plays a significant part in new product and complex (multi-product and/or multi-state) eviCore claims systems client implementations and internal integration/migration efforts
- Define business (BRD), technical (TRD) and claim data exchange requirements (X12 and proprietary formats) and instruct on data file mapping related to provider, member, auths, and claims
- Design solutions for billing rule, benefits and provider configuration
- Create and/or execute test/use case for integration testing, and executing and/or support for associated user acceptance testing, as related to their SME role, to ensure proper interaction for current and future claims product use
- High School Diploma or GED required
- Extensive experience in claim adjudication processes, subject matter expert in system configuration, processing, reporting and issue triage, required
- Experience in reading and triaging files in industry standard claims data types (820, 837, 835, 276/277, 276CA, 997/999), required
- Experience in creating claim test files for load into claim system to support test case execution and test plans/use cases to support end to end testing, required
- Knowledge of claim editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS), required
- Proficient in MS Office products, including Access, Visio and PowerPoint, required
- Advanced in Excel , required
- Proficient in SQL querying, required
- Experience working with and updating records within a database management system (DB2, SQL Server)
- Accomplished in claims lifecycle knowledge, Agile Scrum, and claims adjudication framework
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Lead Systems Analyst - Bloomfield, United States - The Cigna Group
Description
Are you ready to drive growth and improve lives? EviCore a line of business within The Cigna Group is hiring a Lead Systems Analyst - Client Support. In this senior level role, you will act as a Subject Matter Expert for eviCore Claims Systems and the suite of eviCore Claim Products. You'll be the primary contact for production issues; triage, new product configuration design, and process-improvement initiatives and the Subject Matter Expert to business and IT for eviCore claims product setups/processes, the eviCore claim systems and related job processes.
What you'll do to make a difference:
What you'll need to succeed:
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 86, ,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.
We want you to be healthy, balanced, and feel secure. That's why 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) with company match, 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, visit Life at Cigna Group .
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 support. Do not 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.
