Job description

Do you want to Drive Growth and Improve Lives? EviCore, a division of The Cigna Group is hiring a Lead Claims Systems Analyst. As a lead you’ll be the primary contact for production issue triage, new claims product configuration design, and process-improvement initiatives. You’ll also be the subject matter expert to external clients, other associates, the business and IT for eviCore claims product setups/processes, the eviCore claim system and related job processes.

How you’ll make a difference:
Analyze existing claims setups and system processes for opportunities to continually improve adjudication automation and accuracy, and update support documentatio

Responsible for new claims products and multi-product and/or multi-state eviCore claims systems client implementations and internal integration/migration efforts.

Design solutions for billing rule, benefits and provider configuration

Define business, technical and claim data exchange requirements, instruct on data file mapping (such as provider, member, auths, claims, etc.)

Provide support to the Claims Systems Analysts and other internal departments, as well as, external clients and vendors

Communicate concepts and insights to business leaders and partners internal and external client business operations, IT departments and QA departments to support these requirements in a relevant and actionable manner

Collaborate with the business and technology and analytics teams to execute project initiatives, resolve issues and develop new data sources for reporting.

Act as Subject Matter Expert (SME) for eviCore claim systems and related job processes internally and externally

Create test/use cases, SI testing, and provide support for associated UA testing, as related to their SME role, to ensure proper interaction for current and future claims product use

What you’ll need to succeed:
High School Diploma or GED required, bachelor's degree preferred

3+ years of healthcare claims life cycle experience, emphasis in claims system requirements analysis and billing rule, benefits and provider configuration design required

3+ years of experience in claim adjudication and subject matter expert in system configuration, processing, reporting and issue triage required

3+ years of experience creating test plans/use cases to support end to end testing required

2+ years of experience as a subject matter expert in claims configuration, leading a team of other associates preferred

Excellent Client facing communication and presentation skills required

Proficient in MS Office products; Excel, Visio and PowerPoint required

Proficient with MS Access and SQL queries required

Skilled in analyzing business and user requirements, claims systems configuration and translating into proper claims system requirement specifications required

Knowledge of standard claims data types (837, 835, 277, 999) and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS preferred

What you’ll love about working here:
1st day benefits - Medical Dental Vision & etc.

18 days Paid Time Off

8 Paid Holidays

Paid Caregiver leave

Employer Contributions for HRA and HSA accounts

401K with Company Match

Tuition Assistance

Advancement opportunities

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 58,100 - 96,900 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: 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.

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