Job Description

Do you want to Drive Growth and Change Lives? EviCore, a division of the Cigna Group is hiring several Claims Systems Configuration Quality Review Senior Analysts. This role requires the review of our claims system to ensure all configurations were input correctly per the specifications of the provider. The Claims Configuration Quality Review Senior Analyst will have in depth knowledge of the eviCore claims systems and products. As the Subject matter expert, you\'ll partner with the Claims Configuration Associates, internal departments, external clients and vendors to ensure configurations have met client requirements and quality standards.

What you\'ll do

• Resolve non-routine issues escalated from leadership, business, clients and junior team members and act as a subject matter expert (SME) to business and IT for eviCore claims product setups/processes

• Collaborate with internal and external clients to understand, and evaluate processes, procedures, job aids and identify solutions for procedural gaps

• Analyze business and user requirements to design solutions and system configurations, specifications, create test plans/use cases perform SI testing, end to end testing and continuously improve adjudication automation and accuracy.

• Partner with technology and analytics teams to develop new data sources for reporting and act as liaison between business and technology to execute project initiatives, and resolve issues

What you\'ll need:

• High School Diploma or GED required
• 5+ years of healthcare claims lifecycle; configuration design, editing, claims system requirements, and analysis required
• 3+ years of experience in Microsoft ACCESS and EXCEL required
• 3+ years of experience with SQL querying, database management systems, creating test plans/use cases, and SDLC models required
• 3+ years of experience with AS400, MC400, McNet and RC3 systems required
• 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.

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: 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.

eQuest