Clinical RN High Cost Claimant Analyst

🔥 16 minutes ago

🗽 New York – Remote

🗽 New York – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Review high cost claimant reports from Client Management, clinical value analytics, and Underwriting teams. • Analyze clinical and claims information, including diagnoses, claim history, current clinical status, and potential future claim impact. • Prepare clear clinical summaries and reporting that support internal business partners and client-related discussions. • Review clinical documentation and notes using applicable Cigna and CGHB clinical documentation and reporting systems. • Participate in meetings and conference calls to discuss high cost claimant reports, trends, and requested follow-up information.

🎯 Requirements

• Active Unencumbered Registered Nurse license in state of residence. • Certified Case Manager (CCM) certification or Bachelor of Science in Nursing (BSN) strongly preferred. • Case management experience and claims payer experience. • Experience reviewing high cost claims, clinical documentation, and claims history. • Ability to use clinical documentation and reporting systems, including Cigna and CGHB systems. • Demonstrated ability to work independently, manage variable workloads, and meet time-sensitive deadlines. • Experience communicating with clinical and non-clinical partners, including Sales, Client Management, and Underwriting.

🏖️ Benefits

• Flexible work arrangements