Position Summary Evernorth Accountable Care is a new business focused on partnering with healthcare providers to form value-based care relationships, improving care for patients, and reducing total healthcare costs. Evernorth Accountable Care will be delegated select claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers. In support of the launch of the claims processing capabilities, Evernorth Accountable Care is building out its Claim Operations team and adding Operations Analysts to support various key operational functions related to claim processing, claim payment, vendor management, and operational coordination with payer teams.
Essential Functions The Claim Operations Analysts will report to the Sr Manager of Claim Operations and form the new ENAC Claim Operations team. Below are the types of functions the Claim Operations Analyst(s) may support, based on business needs/volume, skillset fit, and organizational design:
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 At least 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
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 61,200 - 102,000 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 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, 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: for support. Do not email 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.
