Provider Data Lead Representative

Job not on LinkedIn

🔥 2 hours ago

🇺🇸 United States – Remote

💵 $24 - $36 / hour

⏰ Full Time

🟠 Senior

📊 Data Scientist

👻 Ghost score 0%

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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

• Execute provider data additions, terminations, and updates • Perform data remediation in HCPM, CPF, and Facets • Implement updates identified through quality audits and performance analyses • Apply contract terms and network business rules • Identify operational risks and issues during data load processes and take corrective action • Validate data accuracy across multiple systems and ensure transmission to downstream platforms • Conduct root cause analysis and implement solutions • Analyze intake requests from matrix partners and execute provider, network, or criteria-level updates • Maintain production and quality standards and document activities in the Daily Activity Log • Participate in testing, validation, and checkout activities for system enhancements • Collaborate within a team while maintaining accountability for individual results • Maintain, correct, and ensure the integrity of provider data to support network quality and improve customer and provider experience

🎯 Requirements

• High school diploma or GED required; some college coursework preferred • 2+ years of demonstrated proficiency using CPF and HCPM required • Proclaim and Facets preferred • Strong understanding of data flow and downstream system impacts • Knowledge of provider structures, including Practitioners, Groups, Facilities, and Ancillaries required • Solid understanding of contracts, networks, and applicable Market Guidebook standards highly preferred • Working knowledge of DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, and Knowledge Exchange highly preferred • Internet connection through a cable broadband or fiber optic internet service provider with at least 10Mbps download/5Mbps upload when working at home • Ability to perform analytical problem solving, root cause analysis, systems thinking, communication, collaboration, time and priority management, and work effectively in ambiguous or evolving environments

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Cable broadband or fiber optic internet service requirement for home working, with at least 10Mbps download/5Mbps upload