Business Project Analyst Claims Systems - EviCore - Remote

The Business Project Analyst is a key role working closely with the claims systems and configuration team, project management, and stakeholder SME’s to develop, improve, monitor, and maintain EviCore Claims Systems. The work will be a mix of project and production support including program configuration, compliance, performance management, root cause analysis, data stewardship, business requirements definition, testing support and validation. This role will report to the Business Solutions Manager focusing primarily on process improvements and strategic initiatives within the Claims Systems Space.

Work can range in content including (but not limited to) Root cause analysis of systemic issues that impact claims processing, performance management, or process improvement. A fundamental understanding of claims processing, configuration, and adjudication is required for success in this role.

Job Components and Deliverables

PROGRAM  MANAGEMENT:

• Production Support – Monitor controls and Identify issues; root cause analysis, solutioning, document and maintain log of issues
• Project Support – Develop and manage detailed business requirements using a combination of stakeholder input and subject matter expertise, document validation requirements (including use case definition, expected results, defect logging, validation and governance of process)

DRIVING SOLUTIONS:

• Root Cause Analysis –analyze data, system workflows, requirements and feeds to determine issue cause and appropriate solutioning suggestions
• Facilitation – lead and document idea sessions around problem resolution to address business needs
• Process – follow portfolio and production processes to resolve issues and identify project needs. Including but not limited to Intake creation, project request forms and collaterals, business case support, status reporting updates, communications surrounding issues and fixes, and governance support (logs, materials, decision support)

COMMUNICATION:

• Sponsorship / Senior Level – Concise, effective communication around progress, risks, timing and decisions needed at the senior level
• Team – Detailed plans and activities to identify timing and ownership.
• Organizational – Clear, effective communication to matrix partners on timing / impact of implementations on their departments.

Cigna Core Competencies

ALIGN:

• Manages Complexity – Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems
• Manages Conflict - Handling conflict situations effectively, with a minimum of noise – applying knowledge of business and the marketplace to advance the organization’s goals
• Collaborates – Building partnerships and working collaboratively with others to meet shared objectives.

INSPIRE:

• Communicates Effectively – developing and delivering multi-modal communications that deliver a clear understanding of the unique needs to different audiences
• Persuades – Use compelling arguments to gain the support and commitment of others

DEVELOP:

• Nimble Learning – Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.
• Situational Adaptability – Adapting approach and demeanor in real time to match the shifting demands of different situations
• Tech Savvy – Anticipating and adoptinginnovationsinbusiness-buildingdigitalandtechnologyapplications.

DELIVER:

• Drives Results – holding self accountable to meet commitments
• Action-Oriented – consistently achieving results, even under tough circumstances
• Optimizes Work Processes – Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement.

BASIC QUALIFICATIONS:

• High School Diploma or GED required
• 3+ years of experience with claims adjudication engines (CAE) required (ex: Facets, QNXT, HRP)
• Experience with documenting business requirements for configurations and adjudi