Do you want to Drive Growth and Change Lives? EviCore, a line of business within The Cigna Group, is hiring a Claims System Configuration Lead Analyst. This highly technical systems role acts as the Subject Matter Expert (SME) for the Configuration of the eviCore Claims Systems and the suite of eviCore Claim Products. You’ll be the primary contact for vendors and clients for production issue triage, new product configuration design, and process-improvement initiatives. You'll be the subject matter expert to the business and IT for eviCore claims product setups/processes, the eviCore claim system and related job processes.
What you’ll do to make a difference:
Be the Subject Matter Expert for the eviCore claim systems, related job processes and provide SME support to Claims Systems Analysts and other internal departments, and external clients and vendors
Collaborate with associates, senior analysts, team leads and supervisors to identify solutions for procedural gap to support business needs
Support and lead client implementations and internal integration/migration efforts, and change requests, design documentation creation and/or approval
Resolves escalated systems issues from leadership, business, clients and junior team members
Analyze existing setups and system processes for opportunities to continually improve adjudication automation and accuracy, and update support documentation as necessary
Communicates concepts and insights to business leaders and partners in a relevant and actionable manner
Collaborate with technology and analytics teams to develop new data sources for reporting
Act as liaison between business and technology to execute project initiatives, and resolve issues - research and respond to questions in relation to process, requirements and testing
Responsible for new product and complex (multi-product and/or multi-state) eviCore claims systems client implementations and internal integration/migration efforts
Responsible for leading discussions with cross-functional teams, to understand, and evaluate processes, procedures (standard operating procedures, job aids, and work instructions)
Define business, technical and claim data exchange requirements, instruct on data file mapping (such as provider, member, auths, claims, etc.)
Design solutions for billing rule, benefits and provider configuration
Creating test/use cases, SI testing, and providing support for associated UA testing, as related to their SME role, to ensure proper interaction for current and future claims product use
What you need to succeed:
High School Diploma, required, bachelor’s degree preferred
3+ years of experience as a subject matter expert for claims system configuration, processing, reporting, issue triage and testing - REQUIRED
Project Management Experience - REQUIRED
Six Sigma Certification - REQUIRED
Experience in creation of test plans/use cases to support end to end testing - REQUIRED
Advanced experience with MS ACCESS - REQUIRED
Advanced experience with MS EXCEL - REQUIRED
Advanced experience with SQL and SQL querying - REQUIRED
Experience with all MS office products including PowerPoint - REQUIRED
5+ years of healthcare claims life cycle experience, emphasis in claims system requirements analysis and billing rule, benefits and provider configuration design - REQURED
Must be highly productive in a fast pace, dynamic organization and skilled in analyzing business and user requirements, and translating into proper system requirement specifications - REQUIRED
Excellent written, oral communication, client-based communication skills and interpersonal skills - REQUIRED
Client facing communication and presentation skills, strongly preferred
Knowledge of industry standard claims data types (837, 835, 277, 999) and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS) preferred
Knowledge of database management systems (DB2, SQL Server), preferred
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.
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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