Category: Customer Service & Claims - Two Chicks With A Side Hustle

Do you want to Drive Growth and Improve Lives? Do you have advanced technology skills with Claims Systems Configuration, SQL querying, MS Access, Excel and database management? Then read on… EviCore, a division of The Cigna Group is hiring a Claims Systems Configuration Senior Analyst. For this senior level role, you’ll be responsible to resolve escalated systems issues from leadership, business, clients and junior team members and act as a subject matter expert (SME) to the business and IT for eviCore claims product setups and processes.

What you’ll do to make a difference:

Provides direction and guidance to the team regarding policies, procedures, workflows, and claims service quality

Completes day-to-day Configuration tasks without immediate supervision but has ready access to advice from more experienced team members
Analyze complex business requirements to configure claim rules within the functionality of the system and responsible for monitoring claim service standards
Manage the accurate and timely additions of claims rules and administers disposition according to requirements and company policies and procedures

Communicates and educates regarding issues/trends to minimize errors
Resolves non-routine issues escalated from more junior team members

What you’ll need to succeed:

High School Diploma or GED Required
5+ years of healthcare claims lifecycle; configuration design, editing, claims system requirements, and analysis Required
3+ years of ADVANCED experience in Microsoft ACCESS and EXCEL REQUIRED

3+ years of ADVANCED experience with SQL querying, database management systems REQUIRED
3+ years creating test plans/use cases, and SDLC models required
3+ years of experience with AS400, MC400, McNet and RC3 systems required preferred

3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS)

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 51,500 – 85,800 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 Group.

About Evernorth Health ServicesEvernorth 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, prevention and treatment of illness and disease more accessible to millions of people. 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: [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.

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.

APPLY HERE!