Cigna in
Plan Implementation Sr. Representative - Evernorth - Remote
Cigna in, Bloomfield, Connecticut, us, 06002
Overview
Plan Implementation Sr. Representative - Evernorth - Remote (Finance)
Summary: Manages provider demographic and reimbursement data for Client Specific Networks. Reports to client contacts and collaborates with internal teams to ensure accurate provider systems for claims and directories. Supports Provider Loading projects as needed.
Responsibilities
Load and configure system applications for managed care contracts.
Maintain and update client-specific network data.
Manage network maintenance tasks.
Interpret and apply CSN contracts using appropriate tools.
Partner with Business Intelligence to automate networks and resolve claim issues.
Perform root cause analysis and resolve issues using internal resources.
Ensure provider data accuracy and network quality.
Investigate and resolve claim issues.
Audit data for system alignment and integrity.
Lead process improvements and automation initiatives.
Communicate demographic and reimbursement setups to matrix partners.
Identify workflow improvements and volume reduction opportunities.
Qualifications
High school diploma or GED required.
1+ years of experience working with managed care data systems and claims applications (e.g., Proclaim and/or HCPM) highly preferred.
Experience with account management/handling a book of business is highly preferred.
Strong technical, analytical, and decision-making skills.
Proficient in Microsoft Office (Excel experience using pivot tables and VLOOKUPs is highly preferred).
Able to manage multiple tasks independently.
Accurate data management and strong communication skills.
Competencies
End-to-end process knowledge
Critical thinking
Prioritization
Organization
Responsiveness
Clear communication
Customer focus
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 24 - 37 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.
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Summary: Manages provider demographic and reimbursement data for Client Specific Networks. Reports to client contacts and collaborates with internal teams to ensure accurate provider systems for claims and directories. Supports Provider Loading projects as needed.
Responsibilities
Load and configure system applications for managed care contracts.
Maintain and update client-specific network data.
Manage network maintenance tasks.
Interpret and apply CSN contracts using appropriate tools.
Partner with Business Intelligence to automate networks and resolve claim issues.
Perform root cause analysis and resolve issues using internal resources.
Ensure provider data accuracy and network quality.
Investigate and resolve claim issues.
Audit data for system alignment and integrity.
Lead process improvements and automation initiatives.
Communicate demographic and reimbursement setups to matrix partners.
Identify workflow improvements and volume reduction opportunities.
Qualifications
High school diploma or GED required.
1+ years of experience working with managed care data systems and claims applications (e.g., Proclaim and/or HCPM) highly preferred.
Experience with account management/handling a book of business is highly preferred.
Strong technical, analytical, and decision-making skills.
Proficient in Microsoft Office (Excel experience using pivot tables and VLOOKUPs is highly preferred).
Able to manage multiple tasks independently.
Accurate data management and strong communication skills.
Competencies
End-to-end process knowledge
Critical thinking
Prioritization
Organization
Responsiveness
Clear communication
Customer focus
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 24 - 37 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.
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