- Facilitate implementation of new health plan into the eviCore claims systems
- Work directly with clients and vendors to ensure highest quality standards are met for all configuration implementation process
- Resolve escalated issues from leadership, business, clients and junior team members and act as a subject matter expert (SME) to business and IT for eviCore claims product setups/processes
- Collaborate with internal and external clients to understand, and evaluate processes, procedures, job aids and identify solutions for procedural gaps
- Analyze business and user requirements to design solutions and system configurations, specifications, create test plans/use cases perform SI testing, end to end testing and continuously improve adjudication automation and accuracy.
- Partner with technology and analytics teams to develop new data sources for reporting and act as liaison between business and technology to execute project initiatives, and resolve issues
- High School Diploma or GED required
- 5+ years of healthcare claims lifecycle; Claims systems configuration design, editing, claims system requirements, and analysis - REQUIRED
- 3+ years of experience with MS ACCESS - REQUIRED
- 3+ years of experience with SQL and SQL querying - REQUIRED
- 3+ years of experience with database management systems required
- Advanced experience with EXCEL required (formulas, V-Lookups, pivot tables) - REQUIRED
- 3+ years of experience creating test plans/use cases, and SDLC models - REQUIRED
- 3+ years of experience with AS400, MC400, McNet and RC3 systems - Strongly Preferred
- 3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS) - REQUIRED
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Claims System Configuration Senior Analyst - Remote, United States - The Cigna Group
Description
Do you want to Drive Growth and Change Lives? EviCore, a division of the Cigna Group is hiring a Claims Systems Configuration Senior Analyst. For this crucial senior level role, you'll provide support to Claims Systems Configuration Associates, internal departments, external clients and vendors. You'll define business, technical and claim data exchange requirements, instruct on data file mapping (such as provider, member, authorizations, claims, etc.), design solutions and system configuration. You'll create test/use cases, perform SI testing, and provide support for associated UA testing in order to successfully complete eviCore claims systems client implementations, internal integration/migration efforts, and large scope projects. The Claims Systems Configuration Senior Analyst will be responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments to support these requirements. to ensure configurations have met client requirements and quality standards.
What you'll do to Drive Growth and Improve Lives:
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 51, ,400 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 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.
