Lead Systems Analyst (Claims) - eviCore - Work from Home
The Claims Systems Lead Analyst position is the Subject Matter Expert for eviCore Claims Systems and the suite of eviCore Claim Products.
This position will be the primary associate for production issue triage, new product configuration design, and process-improvement initiatives as the subject matter expert to business and IT for eviCore claims product setups/processes, the eviCore claim system and related job processes.
- Resolves non-routine issues escalated from leadership, business, clients and junior team members
- Participate in projects to support business initiatives and drive increased operational efficiency
- Working with subject matter experts, team leads and supervisors to identify solutions for procedural gap to support business needs
- Responsible for leading discussions with cross-functional teams, to understand, and evaluate processes, procedures (standard operating procedures, job aids, and work instructions)
- Plays a significant part in client implementations and internal integration/migration efforts, as well as, change requests, design documentation creation and/or approval
- Participation in requirement sessions and perform testing of applications/databases in all environments
- In addition, this position will be responsible for researching and responding to questions in relation to process, requirements and testing
- Completes day-to-day project tasks without immediate supervision. Tasks involve a degree of forward planning and anticipation of needs/issues
- The associate will be responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments to support these requirements
- Act as Subject Matter Expert for the eviCore claim systems and related job processes
- Provide SME support to Claims Systems Analysts and other internal departments, as well as, external clients and vendors
- Provide production support research and resolution for claim system related issues
- Analyze existing setups and system processes for opportunities to continually improve adjudication automation and accuracy, and update support documentation as necessary
- Ability to communicate concepts and insights to business leaders and partners in a relevant and actionable manner
- Collaborate with technology and analytics teams to develop new data sources for reporting.
- Act as liaison between business and technology to execute project initiatives, and resolve issues
- Responsible for prioritization and execution of assigned tasks and ability to identify needed actions with limited direction
- Responsible for new product and complex (multi-product and/or multi-state) eviCore claims systems client implementations and internal integration/migration efforts
- Define business, technical and claim data exchange requirements, instruct on data file mapping (such as provider, member, auths, claims, etc.)
- Design solutions for billing rule, benefits and provider configuration
- Creating test/use cases, SI testing, and providing support for associated UA testing, as related to their SME role, to ensure proper interaction for current and future claims product use.
- High School Diploma; Bachelor's preferred
- 3+ years of healthcare claims life cycle experience, emphasis in claims system requirements analysis and billing rule, benefits and provider configuration design is preferable
- Experience in claim adjudication subject matter expert in system configuration, processing, reporting and issue triage
- Highly productive in a fast pace, dynamic organization
- Skilled in analyzing business and user requirements, and translating into proper system requirement specifications
- Experience in creation of test plans/use cases to support end to end testing.
- Proficient in MS Office products, including Access, Visio and Powerpoint
- Advanced in Excel
- Working knowledge of SQL
- Requirements analysis, system configurations and adjudication framework
- Excellent written, oral communication, client based communication skills and interpersonal skills
- Client facing communication and presentation skills
- Knowledge of industry standard claims data types (837, 835, 277, 999) and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS) preferred
- Knowledge of database management systems (DB2, SQL Server)
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 annual salary of 58,100 - 96,900 USD / yearly, 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 .
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?
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 familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.