Claims Systems, Business Solutions Lead Analyst - eviCore - Remote

The Cigna Group; United States; Remote; USD 74,000 - 124,000; Full time

Job summary

Join a forward-thinking company as a Claim Systems, Business Solutions Lead Analyst, where your technical expertise will drive impactful projects in claims systems. In this dynamic role, you will lead the implementation of enhancements, gather comprehensive business requirements, and collaborate with internal and external stakeholders to ensure successful project delivery. With a focus on the healthcare industry, you will utilize your strong communication and organizational skills to navigate complex systems and support clients effectively. Embrace the opportunity to make a difference in the lives of many while enjoying a comprehensive benefits package and a supportive work environment.

Benefits

Medical benefits

Vision benefits

Dental benefits

401(k) with company match

Tuition reimbursement

Paid time off

Paid holidays

Life insurance

Qualifications

• 5+ years of experience in claims systems implementation and enhancement.
• Strong knowledge of end-to-end claims adjudication processes.

Responsibilities

• Manage multiple complex implementation projects simultaneously.
• Gather business requirements and support client interactions.

Skills

Claims Adjudication System implementation

SQL

Healthcare industry data standards

Strong communication skills

Organizational skills

Education

High School diploma or GED

Bachelor’s degree in information technology or computer science

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:

1. Manage multiple, concurrent implementation/enhancement projects with high degree of complexity at any given time
2. Lead implementation/enhancement activities such as requirements gathering, training, testing, monitoring of deliverables/tasks, post launch warranty support
3. Support client interactions and execute communications
4. Guide clients and internal stakeholders toward the best process and provide answers to ensure their understanding of impacts of requested changes
5. Support feature/user story development
6. Prioritize and manage tasks effectively using time management skills
7. Ensure requirements are captured correctly with the most precise detail, preventing significant issues in system implementation
8. Use your technical proficiency to provide support to our technical data analysts for system analysis, technical requirements writing, and data validation
9. 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:

1. High School diploma or GED required, bachelor’s degree in information technology, or computer science highly preferred
2. 5+ years of Claims Adjudication System implementation/migration and/or claim adjudication engine enhancement experience
3. Knowledge of healthcare industry data standards and formats – X12, JSON, XML, Delimited, etc.
4. Strong knowledge of end-to-end claims adjudication processes
5. Advanced experience with SQL
6. Proficient technology skills; Microsoft Office, Excel, Visio, Confluence, and Smartsheet
7. Understanding of Agile Methodology
8. Strong communication skills (interfacing between external and internal stakeholders)
9. Strong organizational, time management skills with ability to prioritize tasks effectively
10. 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.