Claims Systems, Business Solutions Lead Analyst - eviCore - Remote

Cigna; Bloomfield (IA); Remote; USD 74,000 - 124,000; Full time

Job summary

An established industry player is seeking a Claims Systems, Business Solutions Lead Analyst to enhance their business solutions. This role involves managing complex implementation projects, gathering detailed requirements, and collaborating with both internal and external stakeholders. The ideal candidate will have extensive experience in claims adjudication systems and a strong understanding of healthcare data standards. With a focus on innovation and client support, this position offers a unique opportunity to drive impactful changes in the healthcare sector. Join a dynamic team dedicated to improving business solutions and client satisfaction.

Benefits

Medical benefits

Vision insurance

Dental insurance

401(k) with company match

Tuition reimbursement

Paid time off

Paid holidays

Life insurance

Qualifications

• 5+ years of experience in claims adjudication system implementation.
• Strong knowledge of healthcare data standards like X12, JSON, and XML.

Responsibilities

• Manage multiple implementation projects with high complexity.
• Gather business requirements and support feature development.

Skills

Claims Adjudication System implementation

SQL

Healthcare industry data standards

Communication skills

Organizational skills

Agile Methodology

Time management

Education

High School diploma or GED

Bachelor's degree in Information Technology

Tools

Microsoft Office

Excel

Visio

Confluence

Smartsheet

Job description

Ready to work with a team that improves our business solutions? Do you have a high degree of technical expertise in claims systems? EviCore, a line of business within the Cigna Group, is hiring a Claim Systems, Business Solutions Lead Analyst to provide focused support on implementations, expansions, and client support requests. The Lead Analyst will be responsible for gathering business requirements from internal clients across several disparate systems and external clients, compiling them into a comprehensive set of requirements for presentation to internal and external stakeholders. This role will work closely with external clients, internal stakeholders, project managers, claims systems, claims product and planning and claims development teams on feature/user story development to ensure projects are delivered on time and within scope.

What You'll do:

• Manage multiple, concurrent implementation/enhancement projects with high degree of complexity at any given time
• Lead implementation/enhancement activities such as requirements gathering, training, testing, monitoring of deliverables/tasks, post launch warranty support
• Support client interactions and execute communications
• Guide clients and internal stakeholders toward the best process and provide answers to ensure their understanding of impacts of requested changes
• Support feature/user story development
• Prioritize and manage tasks effectively using time management skills
• Ensure requirements are captured correctly with the most precise detail, preventing significant issues in system implementation
• Use your technical proficiency to provide support to our technical data analysts for system analysis, technical requirements writing, and data validation
• Collaborate with external clients, internal stakeholders, project managers, claims systems, claims product and planning and claims development teams on feature/user-story development to ensure projects are delivered on time and within scope

Requirements :

• High School diploma or GED required, bachelor's degree in information technology, or computer science highly preferred
• 5+ years of Claims Adjudication System implementation/migration and/or claim adjudication engine enhancement experience
• Knowledge of healthcare industry data standards and formats - X12, JSON, XML, Delimited, etc.
• Strong knowledge of end-to-end claims adjudication processes
• Advanced experience with SQL
• Proficient technology skills; Microsoft Office, Excel, Visio, Confluence, and Smartsheet
• Understanding of Agile Methodology
• Strong communication skills (interfacing between external and internal stakeholders)
• Strong organizational, time management skills with ability to prioritize tasks effectively
• Ability to travel to client sites as required

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 74,400 - 124,000 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: [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.