As a member of the Provider Solutions and Operations team, this role supports the Service Model through claim problem analysis, root cause identification, and resolution. This is an internally facing role supporting the Accounts Receivable Management team and the dedicated Gold-tier and Silver-tier participating providers.
Duties and Responsibilities:
- Collaborates with matrix partners to identify, resolve and improve Accounts Receivable issues by utilizing claim knowledge, research and critical thinking skills
- Routinely engages, consults and influences matrix partners to achieve service improvements and minimize contract interpretation
- Drives root cause analysis trending related to accounts receivable resolution
- Leads efforts to research system issues and identify appropriate solutions for the business operations
- Manages escalated issues received through appropriate workflow tools
- Communicates recommendations for changes to improve service as identified through root cause analysis
- Communicates and educates internally regarding issues/trends to minimize errors and improve claim accuracy
- Understands how contract set up and current business policies and technology will affect claim payment
- Participates in meetings as needed to act as a Claim Subject Matter Expert
- Provides education on AR processes to internal partners
- May participate in or lead special project initiatives
- Achieves and or exceeds Service Level Agreements
Qualifications:
- High school diploma or GED required
- 3+ years of experience in claims administration and claim processing preferred
- Advanced knowledge of Proclaim, Facets and/or other Cigna claim processing systems required
- Intricate knowledge of current claim business practices, policies and procedures, the ability to link that knowledge to the multiple aspects of technology and the output of claim payment with the ability to navigate across business units to identify root cause required
- Proficient in Excel- basic formulas, V lookups, filtering, formatting
- Skills to include time management, task analysis and breakdown and resource utilization
- Understanding of the affect that the end result has on Provider satisfaction
- Demonstrated ability to successfully interact with both internal and external customers at all levels
- Demonstrated ability to take ownership of tasks/projects and perform work under minimal supervision with exceptional outcomes
- Demonstrated ability to see the "big picture" and understand how each phase of the claims payment process affects the end result and provider satisfaction
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 The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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 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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group 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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
