Claims Systems Senior Analyst - EviCore

The Claims System Senior Analyst role at EviCore, a Cigna Group business, involves reviewing and configuring claims processing systems to ensure accuracy and compliance. The position requires in-depth knowledge of claims systems and collaboration with internal and external stakeholders.

Location: Remote (US)

Salary: $55,100–$91,800/yr

Responsibilities

• 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
• Provide support with production issues as needed

Requirements

• High School Diploma or GED required, bachelor’s degree preferred
• 5+ years of healthcare claims lifecycle; configuration design, editing, claims system requirements, and analysis
• 3+ years of experience in MS ACCESS
• 3+ years of advanced experience with MS EXCEL
• 3+ years of experience with SQL and SQL querying
• 3+ years of experience with database management systems, creating test plans/use cases, and SDLC models
• 3+ years of experience with MC400, McNet and RC3 systems (Preferred)
• 3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS) (Preferred)

Benefits

• Comprehensive health benefits including medical, vision, dental, and well-being programs
• 401(k) plan
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year and paid holidays

Additional Information

• Candidates working remotely must have internet with at least 10Mbps download/5Mbps upload speeds.
• The role is eligible for an annual bonus.
• The company is committed to diversity and equal employment opportunity.
• Applicants needing accommodations should contact seeyourself@thecignagroup.com.