Claims Analyst
- 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
- Supports and drives process improvement to further enhance claim accuracy outcomes
- Support LifeSOURCE Transplant Care Coordinators by performing Referral Intake and following up on existing referrals as needed
- Responsible for auditing new team members during OJT (on the job training)
- Engagement, partnership with manager and claim processing team; team huddles, team meetings, service strategy
- Participates in system release reviews and check outs.
- Works with team to design and implement changes to operations as required
- 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.
- 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
- Additional duties as assigned
Qualifications
- 2+ years of claim processing technical knowledge and application
- 2+ years of previous LifeSOURCE experience
- 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, HCPM, SANP, Facets, LRCM, etc.
- Comfortable working with others in multiple locations; office and work at home
- 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.
At The Cigna Group, 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), 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, click here.
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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
