Quality Assurance Claims Systems Auditor, Senior Analyst - EviCore - Remote

Cigna in; Franklin (TN); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare is seeking a Quality Assurance Claims Systems Auditor, Senior Analyst. You will ensure the accuracy of claim data and compliance with regulations, while utilizing your expertise in claims systems configuration and analysis. This remote position offers an opportunity to drive growth and improve lives through effective contract management and data integrity. Ideal candidates have a strong background in healthcare laws and policies.

Qualifications

• 3 years experience in Claims Systems.
• Strong knowledge of claims lifecycle and healthcare billing.
• Ability to work independently and in teams.

Responsibilities

• Audit contract details for accuracy in claims systems.
• Review provider contracts for compliance.
• Develop and deliver staff training on contract management.

Skills

Claims Systems Configuration

ICD-10

CPT Coding

Claims adjudication

Data analysis

Problem-solving

Communication

Interpersonal skills

Education

Bachelor's degree in Business Administration

Bachelor's degree in Healthcare Management

High school diploma or GED

Tools

Microsoft Office

Claims management systems

Data analysis tools

Plexis

MedSuite

Job description

Quality Assurance Claims Systems Auditor, Senior Analyst - EviCore - Remote (Finance)

Are you passionate about driving growth and improving lives?

EviCore, a division of The Cigna Group, is seeking a Quality Assurance Claims Systems Auditor, Senior Analyst. In this role, you'll audit contract details loaded into our claims systems to ensure accuracy and quality. As a senior professional, you will independently manage claims systems and processes, ensuring data integrity, security, and process optimization for EviCore's claims processing.

Key Responsibilities:

• Review and analyze provider contracts for compliance with policies and regulations
• Verify data accuracy in claims systems, resolving discrepancies
• Collaborate with departments for accurate data entry and contract implementation
• Provide feedback and recommendations to improve processes
• Maintain documentation related to contract reviews and data checks
• Assist in developing and delivering staff training on contract management and data entry

Qualifications:

• High school diploma or GED required; Bachelor's degree in Business Administration, Healthcare Management, or related field preferred
• At least 3 years of experience in Claims Systems Configuration, ICD-10, CPT Coding, Claims adjudication, and manual claims intervention
• Proficiency in Microsoft Office; experience with claims management systems and data analysis tools preferred
• Experience with Plexis and MedSuite preferred
• Knowledge of the claims lifecycle and healthcare billing practices
• Strong communication and interpersonal skills
• Ability to work independently and in teams
• Excellent problem-solving skills

Additional Requirements:

• Reliable internet connection (cable or fiber optic, at least 10Mbps download/5Mbps upload) if working remotely

About Evernorth Health Services:

Evernorth, a division of The Cigna Group, develops pharmacy, care, and benefit solutions to enhance health and vitality. We innovate to make illness prediction, prevention, and treatment more accessible. Join us to drive growth and improve lives.

We consider all qualified applicants without regard to race, color, age, disability, sex, pregnancy, or other protected characteristics. For accommodations during the application process, contact [e-mail].

The Cigna Group maintains a tobacco-free policy and may not hire tobacco/nicotine users in certain states unless they participate in a smoking cessation program. Candidates with criminal histories will be considered in accordance with applicable laws.