Provider Data Lead Representative

Job not on LinkedIn

🔥 13 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

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

• 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 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, including timely documentation in the Daily Activity Log • Support system enhancement initiatives through testing, validation, and checkout activities • Collaborate with the team while maintaining accountability for individual results

🎯 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 • Must have cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload when working from home

🏖️ 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 • Work-at-home arrangement • Cable broadband or fiber optic internet requirement with at least 10Mbps download/5Mbps upload