Claims Analyst, Team Lead - Evernorth Health Services - Remote

Claims Analyst – Team Lead

Responsibilities:

• Responsible for the technical development and support for a team of claim processors:
• Provides support for questions; timely, efficient, accurate responses
• Supports, educates and reinforces the consistent claim process flow
• Provides individual and/or group coaching and development
• Facilitation of training delivery for specified current and/or new information
• Supports the Service Quality Review Meeting (SQRM) process for trends and root cause identification; provides backup support to auditor
• Supports and drives process improvement to further enhance claim accuracy outcomes
• Accountable for the team’s overall quality results
• Engagement, partnership with manager, auditor, and claim processing team; team huddles, team meetings, service strategy
• Participates in system release reviews and check outs.
• Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams.
• Identifies steps necessary to process a varying complexity of contracts for pricing accuracy
• Researches, analyzes and calculates claims in accordance with provider contracts
• Works with internal matrix partners to resolve pended claims issues
• Other duties as assigned

Qualifications:

• 5 years plus of LifeSource claim processing technical knowledge and application
• Customer Service Driven; ability to meet and exceed the internal partner and external customer expectations
• Take accountability in critical thinking and decision making outcomes
• Problem solving skills; utilization of technical skills and resources to ensure accuracy of final claim resolution
• Strong communication skills, both verbal and written
• Ability to teach, educate, coach others through a variety of claim complexities
• Process improvement skills; ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions
• Fluent understanding and application of key tools and resources for claim processing; KnowledgeXchange, Calculators, CPF/PWB, LRCM, PCRS, etc.
• Comfortable working with others in multiple locations; office and work at home
• Position requires excellent interpersonal skills; ability to understand and interpret policy provisions, and to present report analysis and meaningful findings in a clear, concise way.
• Basic knowledge with Word, Excel, PowerPoint, WebEx and Outlook preferred

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 23 - 35 USD / hourly, depending on relevant factors, including experience and geographic location.

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 Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or famil