The Cigna Group
Claims Analyst, Team Lead - Evernorth Health Services - Remote
The Cigna Group, Bloomfield, Connecticut, us, 06002
Claims Analyst - Team Lead
Responsibilities:
Responsible for the technical development and support for a team of claim processors:
Provides support for questions; timely, efficient, accurate responses
Supports, educates and reinforces the consistent claim process flow
Provides individual and/or group coaching and development
Facilitation of training delivery for specified current and/or new information
Supports the Service Quality Review Meeting (SQRM) process for trends and root cause identification; provides backup support to auditor
Supports and drives process improvement to further enhance claim accuracy outcomes
Accountable for the team's overall quality results
Engagement, partnership with manager, auditor, and claim processing team; team huddles, team meetings, service strategy
Participates in system release reviews and check outs.
Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams.
Identifies steps necessary to process a varying complexity of contracts for pricing accuracy
Researches, analyzes and calculates claims in accordance with provider contracts
Works with internal matrix partners to resolve pended claims issues
Other duties as assigned
Qualifications:
5 years plus of LifeSource claim processing technical knowledge and application
Customer Service Driven; ability to meet and exceed the internal partner and external customer expectations
Take accountability in critical thinking and decision making outcomes
Problem solving skills; utilization of technical skills and resources to ensure accuracy of final claim resolution
Strong communication skills, both verbal and written
Ability to teach, educate, coach others through a variety of claim complexities
Process improvement skills; ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions
Fluent understanding and application of key tools and resources for claim processing; KnowledgeXchange, Calculators, CPF/PWB, LRCM, PCRS, etc.
Comfortable working with others in multiple locations; office and work at home
Position requires excellent interpersonal skills; ability to understand and interpret policy provisions, and to present report analysis and meaningful findings in a clear, concise way.
Basic knowledge with Word, Excel, PowerPoint, WebEx and Outlook preferred
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 hourly rate of 23 - 35 USD / hourly, 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 Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.
Responsibilities:
Responsible for the technical development and support for a team of claim processors:
Provides support for questions; timely, efficient, accurate responses
Supports, educates and reinforces the consistent claim process flow
Provides individual and/or group coaching and development
Facilitation of training delivery for specified current and/or new information
Supports the Service Quality Review Meeting (SQRM) process for trends and root cause identification; provides backup support to auditor
Supports and drives process improvement to further enhance claim accuracy outcomes
Accountable for the team's overall quality results
Engagement, partnership with manager, auditor, and claim processing team; team huddles, team meetings, service strategy
Participates in system release reviews and check outs.
Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams.
Identifies steps necessary to process a varying complexity of contracts for pricing accuracy
Researches, analyzes and calculates claims in accordance with provider contracts
Works with internal matrix partners to resolve pended claims issues
Other duties as assigned
Qualifications:
5 years plus of LifeSource claim processing technical knowledge and application
Customer Service Driven; ability to meet and exceed the internal partner and external customer expectations
Take accountability in critical thinking and decision making outcomes
Problem solving skills; utilization of technical skills and resources to ensure accuracy of final claim resolution
Strong communication skills, both verbal and written
Ability to teach, educate, coach others through a variety of claim complexities
Process improvement skills; ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions
Fluent understanding and application of key tools and resources for claim processing; KnowledgeXchange, Calculators, CPF/PWB, LRCM, PCRS, etc.
Comfortable working with others in multiple locations; office and work at home
Position requires excellent interpersonal skills; ability to understand and interpret policy provisions, and to present report analysis and meaningful findings in a clear, concise way.
Basic knowledge with Word, Excel, PowerPoint, WebEx and Outlook preferred
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 hourly rate of 23 - 35 USD / hourly, 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 Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.