Create simple to complex SQL queries to review Claim system configuration and claims data
Make updates to configuration via Access Database
Run Postproduction review on claims to validate changes deployed to production are processing as expected
Investigate claim processing to determine Claim Configuration root cause analysis
The associate will be responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments to support these requirements.
Additional responsibilities may include assisting the reporting development team, RFP data processing requests, training, maintenance transition and process/product workflow/documentation.
This associate will perform duties under self-direction and is expected to make decisions as necessary.
Requirements
Bachelor Degree in a computer related field preferred or equivalent work experience
5+ years of claims and health care experience required
5+ years of experience in medical Claims Systems Configuration preferred
Experience running complex queries utilizing Microsoft SQL
Proficient in Microsoft Access Database (including queries and data manipulation) is required
Proficient in Microsoft Excel (including pivot tables, charts and formulas) is required
Strong technical competence, proven critical thinking, and impeccable communication skills are required
Accomplished in claims lifecycle knowledge and claims adjudication framework
Industry standard claims data types and editing rules (ICD, CPT/HCPC, Rev Codes, NCCI).
Familiarity with database management systems (DB2, SQL Server)
External client facing experience preferred
Creating test plans/use cases, and SDLC models.
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.
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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
