41 applicants

Company

Cigna Healthcare · 14 hours ago

Claims Systems Configuration Lead Analyst - eviCore - Remote

United States Work at Home

Full-time

Remote

Mid Level

$61K/yr - $102K/yr

3+ years exp

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Responsibilities

Be the Subject Matter Expert for the eviCore claim systems, related job processes and provide SME support to Claims Systems Analysts and other internal departments, and external clients and vendors

Collaborate with associates, senior analysts, team leads and supervisors to identify solutions for procedural gap to support business needs

Support and lead client implementations and internal integration/migration efforts, and change requests, design documentation creation and/or approval

Resolves escalated systems issues from leadership, business, clients and junior team members

Analyze existing setups and system processes for opportunities to continually improve adjudication automation and accuracy, and update support documentation as necessary

Communicates 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 - research and respond to questions in relation to process, requirements and testing

Responsible for new product and complex (multi-product and/or multi-state) eviCore claims systems client implementations and internal integration/migration efforts

Responsible for leading discussions with cross-functional teams, to understand, and evaluate processes, procedures (standard operating procedures, job aids, and work instructions)

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

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims System ConfigurationSix Sigma CertificationTest Plans/Use CasesHealthcare Claims LifecycleProject ManagementMS AccessMS ExcelSQLMS Office ProductsBusiness Requirements AnalysisClient CommunicationClaims Data Types KnowledgeDatabase Management Systems

Required

High School Diploma, required, bachelor’s degree preferred

3+ years of experience as a subject matter expert for claims system configuration, processing, reporting, issue triage and testing - REQUIRED

Project Management Experience - REQUIRED

Six Sigma Certification - REQUIRED

Experience in creation of test plans/use cases to support end to end testing - REQUIRED

Advanced experience with MS ACCESS - REQUIRED

Advanced experience with MS EXCEL - REQUIRED

Advanced experience with SQL and SQL querying - REQUIRED

Experience with all MS office products including PowerPoint - REQUIRED

5+ years of healthcare claims life cycle experience, emphasis in claims system requirements analysis and billing rule, benefits and provider configuration design - REQUIRED

Must be highly productive in a fast pace, dynamic organization and skilled in analyzing business and user requirements, and translating into proper system requirement specifications - REQUIRED

Excellent written, oral communication, client-based communication skills and interpersonal skills - REQUIRED