Business Project Analyst Claims Systems - EviCore - Remote

Remote Jobs; Poland; Remote; PLN 257,000 - 331,000; Full time

Job summary

A leading health services provider is seeking a Business Project Analyst to enhance claims systems through project management and production support. The role involves data analysis, root cause issues, and coordination with stakeholders. Candidates should have a strong background in claims adjudication engines and business analysis. This position offers remote work flexibility.

Qualifications

• 3+ years of experience with claims adjudication engines such as Facets, QNXT, HRP.
• Experience with documenting business requirements for configurations and adjudication rules.

Responsibilities

• Monitor controls and perform root cause analysis.
• Develop and manage detailed business requirements.

Skills

Claims adjudication engines (CAE) experience

Business Analysis

Agile product support

Education

High School Diploma or GED

Job description

Overview

The Business Project Analyst is a key role working closely with the claims systems and configuration team, project management, and stakeholder SMEs to develop, improve, monitor, and maintain EviCore Claims Systems. The work is a mix of project and production support including program configuration, compliance, performance management, root cause analysis, data stewardship, business requirements definition, testing support and validation. This role reports to the Business Solutions Manager, focusing on process improvements and strategic initiatives within the Claims Systems space. Work can range in content from root cause analysis of systemic issues impacting claims processing to performance management or process improvement. A fundamental understanding of claims processing, configuration, and adjudication is required for success in this role.

PROGRAM MANAGEMENT

• Production Support - Monitor controls; identify issues; perform root cause analysis, solutioning, and document and maintain a log of issues.
• Project Support - Develop and manage detailed business requirements using stakeholder input and subject matter expertise; document validation requirements (including use case definition, expected results, defect logging, validation and governance of process).

DRIVING SOLUTIONS

• Root Cause Analysis - Analyze data, system workflows, requirements, and feeds to determine issue causes and appropriate solutioning suggestions.
• Facilitation - Lead and document idea sessions around problem resolution to address business needs.
• Process - Follow portfolio and production processes to resolve issues and identify project needs, including but not limited to intake creation, project request forms and collateral, business case support, status reporting updates, communications surrounding issues and fixes, and governance support (logs, materials, decision support).

COMMUNICATION

• Sponsorship / Senior Level - Provide concise, effective communication around progress, risks, timing, and decisions needed at the senior level.
• Team - Develop detailed plans and activities to identify timing and ownership.
• Organizational - Communicate clearly and effectively to matrix partners on timing and impact of implementations on their departments.

Cigna Core Competencies

ALIGN

• Manages Complexity - Make sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
• Manages Conflict - Handle conflict situations effectively, with a minimum of noise, applying knowledge of business and the marketplace to advance the organization's goals.
• Collaborates - Build partnerships and work collaboratively with others to meet shared objectives.

INSPIRE

• Communicates Effectively - Develop and deliver multi-modal communications that deliver a clear understanding of the needs to different audiences.
• Persuades - Use compelling arguments to gain support and commitment of others.

DEVELOP

• Nimble Learning - Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.
• Situational Adaptability - Adapt approach and demeanor in real time to match shifting demands of different situations.
• Tech Savvy - Anticipate and adopt innovations in business-building digital and technology applications.

DELIVER

• Drives Results - Hold self accountable to meet commitments.
• Action-Oriented - Consistently achieve results, even under tough circumstances.
• Optimizes Work Processes - Identify the most effective and efficient processes to get things done, with a focus on continuous improvement.

BASIC QUALIFICATIONS

• High School Diploma or GED required.
• 3+ years of experience with claims adjudication engines (CAE) such as Facets, QNXT, HRP.
• Experience with documenting business requirements for configurations and adjudication rules.
• 3+ years of Business Analysis, Agile product support, Project Management, or applicable experience, required.
• Agile / Traditional requirements development / delivery methodology awareness.
• Demonstrated experience and mastery in skills listed above.
• Working knowledge of EviCore operations, systems, and client data.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic provider with speeds of at least 10 Mbps download/5 Mbps 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: [e-mail] for support. Do not email [e-mail] 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.