Cigna Healthcare · 7 hours ago

Claims Systems Configuration Senior Analyst - eviCore - Remote

United States Work at Home

Full-time

Remote

Senior Level

$52K/yr - $86K/yr

5+ years exp

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Responsibilities

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

Qualification

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Claims Systems ConfigurationSQL queryingMicrosoft AccessMicrosoft ExcelDatabase managementClaims lifecycle analysisTest plansSDLC modelsClaims adjudicationMC400McNetRC3 systemsICD codingCPT codingHCPC codingNCCI rulesMPPR rulesOPPS rulesRBRVS rulesFFS rules