Claims Systems Lead Analyst

Job not on LinkedIn

🔥 0 minutes ago

🎸 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • 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

• 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 update tickets for Claims System projects and requests • Mentor the Senior Analyst on complex enhancement and configuration designs • Provide Claims Systems subject matter expertise to internal departments, including Claims Configuration, Client Engagement, Program Leads, Claims IT Development, and QA • Lead external client calls and support clients in all aspects of the Claims System application • Define business, technical, and claims 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 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 production 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 • Proficient in Microsoft Excel, including pivot tables, charts and formulas • Strong technical competence, proven critical thinking, and impeccable communication skills • 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 • Ability to obtain home internet through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Remote work arrangement • Internet connection through a cable broadband or fiber optic internet service provider with minimum speeds of 10Mbps download/5Mbps upload when working from home • Equal employment opportunity protections • Reasonable accommodation support for the online application process • Tobacco/nicotine cessation program eligibility in applicable states