Job description
Remote, work from homeClaims Analyst - Claims is a role within the Cigna Medicare Customer & Client Service Experience Organization. This role is responsible for working with the Cost Avoidance and Recovery internal teams, as well as participating in multiple vendor relationships.
Claims Analyst - Delivers specific delegated Claims tasks assigned by a supervisor. Examines and processes paper claims and/or electronic claims. Determines whether to return, pend, deny or pay claims within policies. Determines steps necessary for adjudication. Follows established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues. Settles claims with claimants in accordance with policy provisions. Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim. Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries. Completes day-to-day tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Works in conjunction with multiple vendor relationships with the ability to handle additional vendors as the Government Business Segment grows.
Assist with implementations related to new vendors for cost avoidance pre-payment/post-payment edits, subrogation
Participate in Implementation of vendor services for new markets or existing Cigna plans
Implement new audits and edits to increase and maximize overall savings
Participates in workgroups to help resolve complex payment issues; involving QNXT/FACETS Configuration, Health Services, Network, and Contracting
Collaborates with counterparts from the Cigna Commercial (ClaimsXten, ClaimCheck, Prepayment editing)
Review unsettled provider disputes for compliant and fair outcome utilizing Call Trackers
Participates in the review and approval process of new Medicare coding edits for claims
Assist manager/supervisor with Legal questions, issues related to edits, audits and reimbursement
Review monthly reports from Suppliers; addressing trends, concerns, spikes or actionable items
Qualifications
5+ years Medicare Advantage experience in cost avoidance arena
Research and identify potential edits to be built from LCD’s, NCD’s, ICD 10 guidelines, CMS/AMA Policies and Vendor reports
Conduct testing, in UAT to ensure all configurations are working appropriately
Responsible for testing all proposed solutions
Proficiency in medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract concepts and common claims processing/resolution practices.
Proficient in Microsoft Office including Outlook, Word, Excel, and PowerPoint.
Complete Market projects that need to be worked and responded to timely
Monitor for Medicare and Medicaid payment and policy changes and ensure they are researched for potential configuration and savings. Analyze CMS/AMA Policy Guidelines, ICD 10 guidelines, and Vendor Reporting
Experience gathering and communicating Policies and Procedures in a simple and easy to understand manner to other team members/management. Document criterion to determine best method of workflow, research and execution
Complete assigned tasks and/or oversee the completion of those tasks within timelines
Understand Center for Medicare/Medicare Services (CMS) claims editing policies
Utilize knowledge of areas related to Claims, e.g. Network Operations, Claims Processing, Pre and Post Pay Vendors, Cost Avoidance and Recovery team members
Demonstrated ability to work independently on multiple projects and priorities
Strong, independent decision-making ability
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 hourly rate of 17 - 26 USD / hourly, 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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