- Maintaining and managing relationships with nine claim clearinghouses
- Serving as a primary liaison to one or more claim payment vendors
- Developing and maintaining operational processes to investigate and resolve claim inquiries and issues reported by providers, payers, customer service, and internal stakeholders
- Establishing operational processes in support of a close partnership with Evernorth Accountable Care Technology Production Support
- Supporting claim adjustments processes, including interfacing with teams at payers to ensure claim adjustments opportunities are identified, prioritized, and processed in an efficient and accurate manner.
- Supporting any manual intervention needed on claims, including late payment interest rules and calculations, liens and garnishment application, refund requests, and more.
- Overseeing and managing a queue for reviewing and resolving claim fallout.
- Partnering with Evernorth Accountable Care's claim product management organization to inform requirements for technology enhancements that support the growth of the business.
- Support business acceptance testing for new technology features that impact claim operations end users.
- Establishing and maintaining processes that require collaboration with various enterprise groups, such as Provider Relations; Fraud, Waste, and Abuse; Accounting; Finance; and more.
- Regularly communicating and presenting on the overall health of Evernorth Accountable Care claim operations to sr. leadership
- Creating and maintaining standard operating procedures for the claim operations team
- Providing onboarding and training to new team members
- Bachelor's Degree or equivalent work experience required
- Previous healthcare claims experience required
- 5+ years of experience in an operations setting required
- 3+ years of leadership experience in an operations setting required
- Proven ability to build, develop, and motivate high performing teams in a fast paced, high impact operations environment
- Ability to delegate work in a manner that maximizes the strengths, skillsets, interests, and growth opportunities of the team
- Experience establishing new operational processes and/or leading teams through a new initiative launch within a highly matrixed organization
- Enthusiasm and passion to meet operational targets
- Strong ability to navigate, communicate, and lead others through a high degree of change
- Strong critical thinking skills and ability to navigate through ambiguity with limited oversight
- Ability to predict challenges and seek to proactively head-off obstacles
- High attention to detail and proven ability to manage multiple, competing priorities simultaneously
- Experience preparing and delivering monthly operating review presentations to sr. leaders
- Proven ability to develop strong working relationships and establish a high level of credibility across teams and lines of business
- Periodic travel required
Claim Operations Senior Manager - Scottsdale, United States - The Cigna Group
Description
Position Summary
Evernorth Accountable Care is a new business focused on partnering with healthcare providers to form value-based care relationships, improving care for patients and reducing total healthcare costs. Evernorth Accountable Care will be delegated select claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers. In support of the launch of the claims processing capabilities, Evernorth Accountable Care is seeking an experienced Claim Operations senior leader to build a high performing team of claim analysts and operations personnel to support the business in ongoing claim operations.
Essential Functions
The Senior Manager of Claim Operations will oversee a team of 3-15 team members (combination of FTEs and contractors) that includes the following responsibilities:
Qualifications