Operations Analyst, Evernorth Accountable Care – Hybrid
The Cigna GroupAbout the role
Evernorth Accountable Care focuses on partnering with healthcare providers to form value-based care relationships, improving care for patients and reducing total healthcare costs. Evernorth Accountable Care is delegated claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers. The Operations Analyst will support various key operational functions related to claim processing, claim payment, vendor management, and operational coordination with payer teams.
Essential Functions
Maintaining and managing relationships with claim clearinghouses
Serving as a primary liaison to one or more claim payment vendors
Developing and maintaining operational processes to investigate and resolve claim inquiries and issues reported by providers, payers, customer service, and internal stakeholders
Establishing a close partnership with Evernorth Accountable Care Technology Production Support to identify and triage production issues.
Supporting claim adjustments processes, including interfacing with teams at payers to ensure claim adjustments opportunities are identified, prioritized, and processed in an efficient and accurate manner.
Supporting any manual intervention needed on claims, including late payment interest rules and calculations, liens and garnishment application, refund requests, and more.
Work through resolving cases in a claim fallout queue by performing root cause analysis and following standard operating procedure
Support business acceptance testing for new technology features that impact claim operations end users.
Maintaining processes that require collaboration with various enterprise groups, such as Provider Relations; Fraud, Waste, and Abuse; Accounting; Finance; and more.
Supporting the creation and maintenance of standard operating procedures for the claim operations team
Qualifications
2+ years of experience in an operations setting required
Previous healthcare experience preferred
High attention to detail and proven ability to manage multiple, competing priorities simultaneously
Strong experience working in Excel with knowledge of how to perform VLOOKUPs, pivot tables, basic functions, and basic data analysis
Strong critical thinking skills and ability to navigate through ambiguity with limited oversight
Enthusiasm and passion to meet operational targets
Strong ability to execute through and adapt to change
Ability to raise risks and issues to leadership in a fact-based approach, leading with a solution proposal
Ability to predict challenges and seek to proactively head-off obstacles
Proven ability to develop strong working relationships in a cross-functional, team environment
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevenApply for this role
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