Must reside within 50 mile radius of 401 Chestnut St. Chattanooga, TN 37402
Must successfully complete 10 weeks of onsite training at 401 Chestnut St. Chattanooga, TN 37402
Position Summary
Utilize Implementation materials to load client specific benefits in the Proclaim claim engine, using macro/BOT technology and manual system entry to support new and existing business.
The PAA will also ensure that account benefits are in compliance with State and Federal legislation.
Responsibilities
Utilize Implementation materials to load client specific benefits in the Proclaim claim engine to support new and existing business.
Review and analyze various documents; such as, contract language, ePro, benefit summaries, and state mandates to ensure the claim engine is in compliance with client intent and benefit standards.
May be involved in benefit review discussions with Proclaim subject matter experts (SMEs) to provide technical insight as requested from internal matrix partners.
Prevent access to care (ATC) issues and resolve member impacting benefit disjoints by updating the claim engine timely based on updated source documents and/or benefit load clarifications
Internally communicates workflow and quality improvement processes when identified.
Qualifications
High School Diploma or GED required, advanced degree preferred
3+ years of experience in the Healthcare Industry, Pharmacy, or PBM highly preferred; or related experience
Intermediate knowledge of MS Office products, specifically MS Excel required
Excellent written communication skills; inclusive of accurately documenting system updates made
Strong verbal communication, analytical and problem-solving skills
Strong organizational, time and inventory management skills
Ability to “learn on the fly” and function in a fast paced and changing environment
Ability to interpret, process, and implement complex information
Ability to accurately self-audit completed system updates
Ability to prioritize and meet deliverables within expected timing
Experience working independently
Knowledge of matrix partner functions and how they interact; preferred
Actively participate in stretch assignments and remediation initiatives
Appropriately use MOS tools including DPL (inventory tracking system)
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 21 - 32 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 The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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.
