Claims Systems Configuration Quality Review Senior Analyst - eviCore - Remote

Do you want to Drive Growth and Change Lives? EviCore, a division of the Cigna Group is hiring a Claims Systems Configuration Quality Review Senior Analyst. For this highly technical role, you'll review our claims system to ensure all configurations were input correctly per the specifications of the provider. The Claims Configuration Quality Review Senior Analyst will have in depth knowledge of the eviCore claims systems and products. As the Subject matter expert, you’ll partner with the Claims Configuration Associates, internal departments, external clients and vendors to ensure configurations have met client requirements and quality standards.

What you’ll do to make a difference:

• Resolve non-routine issues escalated from leadership, business, clients and junior team members and act as a subject matter expert (SME) to business and IT for eviCore claims product setups/processes

• Collaborate with internal and external clients to understand, and evaluate processes, procedures, job aids and identify solutions for procedural gaps

• Analyze business and user requirements to design solutions and system configurations, specifications, create test plans/use cases perform SI testing, end to end testing and continuously improve adjudication automation and accuracy.

• Partner with technology and analytics teams to develop new data sources for reporting and act

• as liaison between business and technology to execute project initiatives, and resolve issues

What you’ll need to succeed:

• High School Diploma or GED required

• Strong analytical skills

• The ability to work independently and as a team

• Strong communication skills

• 5+ years of healthcare claims lifecycle; configuration design, editing, claims system requirements, and analysis required

• 3+ years of experience in Microsoft ACCESS and EXCEL required

• 3+ years of experience with SQL querying, database management systems, creating test plans/use cases, and SDLC models required

• 3+ years of experience with AS400, MC400, McNet and RC3 systems required

• 3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS)

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 51,200 - 85,400 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.

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