Network Operations Senior Analyst at Cigna in Birmingham, Alabama

Job Description:

Summary:

This individual reports directly to the Provider Contracting Manager and will develop and maintain positive relationships with hospital and ancillary providers within the provider network. Will also support the activities of the Contracting Department, including: assisting and supporting the contractual and operational relationship with providers, coordinating provider data bases, credentialing, resolution of claims and appeals.

Essential Functions

• Initiates and maintains effective channels of communication with matrix partners including but not limited to: Claims Operations, Health Services, Credentialing, Legal, Medical Economics, Compliance, and Sales.
  
  


• Assists in resolving elevated and complex provider service complaints. Researches problems and works with internal/external partners/customers to resolve escalated and sensitive issues.
  
  


• Research and investigate provider concerns regarding claims payment, appeals, and resolution of operational issues. Coordinate with Claims Department to research and resolve provider concerns.
  
  


• Respond to provider questions, phone calls, and inquiries in a timely fashion.
  
  


• Manages provider relationships and is accountable for critical interface with providers and business staff.
  
  


• Contributes to the development of alternative network initiatives. Supports analytics required for the network solution.
  
  


• Perform root cause analyses and resolution related to provider concerns, grievances, claims and care delivery.
  
  


• Participate in regularly scheduled meetings with other departments; offer substantive feedback to questions and research thoroughly any unknown issues.
  
  


• Work closely with contracting administrators for needs and support.
  
  


• Be available during working hours to coworkers and others for questions; including multitasking on calls and other similar scenarios.
  
  


• Other duties and responsibilities as assigned.
  
  

Qualifications
High School Diploma required, Bachelor's degree highly preferred

Network Operations or Provider Relations experience preferred

Healthcare experience preferred

Proficient using Microsoft Office suite products

Intermediate level of Excel preferred (knowledge of pivot tables, vlookup, etc)

Excellent presentation and strong organizational skills required.

Excellent time management and relational skills.

Demonstrated analytical skills.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

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.