Claims Systems Configuration Lead Analyst - Driving Innovation in Healthcare Claims Processing at eviCore, a Division of The Cigna Group

Transforming Healthcare Claims Processing: Join eviCore as a Claims Systems Configuration Lead Analyst

At eviCore, a division of The Cigna Group, we're on a mission to revolutionize healthcare by creating innovative pharmacy, care, and benefit solutions that improve health and increase vitality. As a leader in the industry, we're seeking a highly skilled and experienced Claims Systems Configuration Lead Analyst to join our team. In this critical role, you'll be the Subject Matter Expert (SME) for Claims Configuration of our Claims Systems and suite of Claim Products, driving growth and improving lives.

About the Role

As the Claims Systems Configuration Lead Analyst, you'll be responsible for providing expert support to internal departments, external clients, and vendors. You'll collaborate with cross-functional teams to identify solutions for procedural gaps, lead client implementations, and internal integration/migration efforts, and resolve escalated systems issues. Your expertise will be instrumental in continually improving adjudication automation and accuracy, and you'll play a key role in designing solutions for billing rule, benefits, and provider configuration.

Key Responsibilities

• Act as the SME for eviCore Claims Systems, related job processes, and provide support to Claims Systems Analysts and other internal departments, external clients, and vendors.
• Collaborate with associates, senior analysts, team leads, and supervisors to identify solutions for procedural gaps to support business needs.
• Lead client implementations and internal integration/migration efforts, and change requests, design documentation creation, and/or approval.
• Resolve escalated systems issues from leadership, business, clients, and junior team members.
• Analyze existing setups and system processes for opportunities to continually improve adjudication automation and accuracy, and update support documentation as necessary.
• Communicate concepts and insights to business leaders and partners in a relevant and actionable manner.
• Collaborate with technology and analytics teams to develop new data sources for reporting.
• Act as a liaison between business and technology to execute project initiatives and resolve issues.
• Define business, technical, and claim data exchange requirements, instruct on data file mapping, and design solutions for billing rule, benefits, and provider configuration.
• Create test/use cases, conduct SI testing, and provide support for associated UA testing to ensure proper interaction for current and future claims product use.

Essential Qualifications

To succeed in this role, you'll need:

• A High School Diploma; a bachelor's degree is preferred.
• 3+ years of experience as a subject matter expert for claims system configuration, processing, reporting, issue triage, and testing.
• Experience in creation of test plans/use cases to support end-to-end testing.
• Advanced experience with MS ACCESS, MS EXCEL, and SQL querying.
• 5+ years of healthcare claims life cycle experience, with an emphasis on claims system requirements analysis and billing rule, benefits, and provider configuration design.
• Excellent written, oral communication, client-based communication skills, and interpersonal skills.
• The ability to be highly productive in a fast-paced, dynamic organization and skilled in analyzing business and user requirements, and translating them into proper system requirement specifications.

Preferred Qualifications

While not required, the following qualifications are highly preferred:

• Client-facing communication and presentation skills.
• Knowledge of industry-standard claims data types (837, 835, 277, 999) and editing rules (ICD, CPT/HCPC, NCCI, MPPR, OPPS, RBRVS, FFS).
• Knowledge of database management systems (DB2, SQL Server).

What We Offer

At eviCore, we're committed to supporting the whole health of our employees. That's why we offer a comprehensive range of benefits, including:

• A competitive salary ($61,200 - $102,000 per year, depending on relevant factors).
• An annual bonus plan.
• Medical, vision, dental, and well-being and behavioral health programs.
• 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.

Career Growth and Development

As a Claims Systems Configuration Lead Analyst at eviCore, you'll have opportunities for career growth and professional development. You'll work with a talented team of professionals who are passionate about improving healthcare, and you'll have access to training and resources to help you succeed. You'll also have the chance to take on new challenges and expand your skill set, driving your career forward.

Our Culture

At eviCore, we're committed to creating a culture that is inclusive, collaborative, and supportive. We value diversity and believe that a diverse workforce is essential to driving innovation and improving healthcare. We're proud to be an equal opportunity employer, and we welcome applicants from all backgrounds.

Ready to Join Our Team?

If you're a motivated and experienced professional looking to drive growth and improve lives, we want to hear from you. Apply now to join our team as a Claims Systems Configuration Lead Analyst and be part of a dynamic organization that's shaping the future of healthcare.

Equal Employment Opportunity: Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions, 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.