Claims Systems Lead Analyst

Job not on LinkedIn

🕒 October 9

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Manage complex Claims Systems projects and implementations within the claims adjudication engine • Ensure data integrity, data security, and process optimization for EviCore Claims processing • Document and develop application functionality and data configuration • Work from Azure DevOps using project methodologies to maintain and upkeep tickets for Claims System projects and requests • Mentor Senior Analysts on complex enhancement and configuration designs • Provide Claims Systems subject matter expertise to Claims Configuration, Client Engagement, Program Leads, Claims IT Development, and other internal departments • Lead external client calls supporting all aspects of the Claims System application • Define business, technical, and claim data exchange requirements • Instruct on data file mapping for providers, members, authorizations, claims, and related data • Create test/use cases, perform SI testing, and support associated UA testing for client implementations and internal integration/migration efforts • Create simple to complex SQL queries to review Claims System configuration and claims data • Update configuration through Access Database • Conduct postproduction claims reviews to validate deployed changes • Investigate claim processing and perform Claims Configuration root cause analysis • Collaborate and communicate with internal and external business operations, IT, and QA departments • Assist reporting development, RFP data processing requests, training, maintenance transition, and process/product workflow documentation • Perform duties under self-direction and make decisions as necessary

🎯 Requirements

• Bachelor Degree in a computer related field preferred or equivalent work experience • 5+ years of claims and health care experience required • 5+ years of experience in medical Claims Systems Configuration preferred • Experience running complex queries utilizing Microsoft SQL • Proficient in Microsoft Access Database, including queries and data manipulation, required • Proficient in Microsoft Excel, including pivot tables, charts and formulas, required • Strong technical competence, proven critical thinking, and impeccable communication skills required • Accomplished in claims lifecycle knowledge and claims adjudication framework • Knowledge of industry standard claims data types and editing rules, including ICD, CPT/HCPC, Rev Codes, and NCCI • Familiarity with database management systems, including DB2 and SQL Server • External client-facing experience preferred • Experience creating test plans/use cases and SDLC models • For home work, internet connection must be through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Remote work option (occasionally or permanently), subject to cable broadband or fiber optic internet with at least 10Mbps download/5Mbps upload • Tobacco-free policy; qualifying smoking cessation program may be available where legally permissible • Equal employment opportunity • Reasonable accommodation for the online application process