Sr. Systems Analyst - Client Support - eviCore - Work from Home at Cigna in Bloomfield, Connecticut

Posted in General Business 7 days ago.

Type: Full-Time





Job Description:

The Systems Analyst Lead position is the Subject Matter Expert for eviCore Claims Systems and the suite of eviCore Claim Products.

This position will be the primary associate for production issue triage, new product configuration design, and process-improvement initiatives as the subject matter expert to business and IT for eviCore claims product setups/processes, the eviCore claim systems and related job processes.

RESPONSIBILITIES:


  • Act as Subject Matter Expert for the eviCore claim systems and related job processes

  • Completes day-to-day project tasks without immediate supervision.

  • Responsible for prioritization and execution of assigned tasks and ability to identify needed actions with limited direction. Tasks involve a degree of forward planning and anticipation of needs/issues

  • Responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments

  • Lead discussions with cross-functional teams, to understand, document and evaluate processes for opportunities to continually improve automation and accuracy

  • Research and resolve and/or track resolution status for non-routine issues escalated from leadership, business, clients and junior team members

  • Plays a significant part in new product and complex (multi-product and/or multi-state) eviCore claims systems client implementations and internal integration/migration efforts

  • Define business (BRD), technical (TRD) and claim data exchange requirements (X12 and proprietary formats) and instruct on data file mapping related to provider, member, auths, and claims.

  • Design solutions for billing rule, benefits and provider configuration

  • Create and/or execute test/use case for integration testing, and executing and/or support for associated user acceptance testing, as related to their SME role, to ensure proper interaction for current and future claims product use.

QUALIFICATIONS:


  • Extensive experience in claim adjudication processes, subject matter expert in system configuration, processing, reporting and issue triage

  • Experience in reading and triaging files in industry standard claims data types (837, 835, 276/277, 276CA, 997/999)

  • Experience in creating claim test files for load into claim system to support test case execution

  • Knowledge of claim editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS)

  • Extensive experience in creation of test plans/use cases to support end to end testing.

  • Proficient in MS Office products, including Access, Visio and PowerPoint

  • Advanced in Excel

  • Proficient SQL querying proficiency

  • Experience working with and updating records within a database management system (DB2, SQL Server)

  • Accomplished in claims lifecycle knowledge, Agile Scrum, and claims adjudication framework

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 82,300 - 137,100 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 .

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, 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 us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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.

Cigna 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.





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