drjobs Operations Analyst, Evernorth Accountable Care – Hybrid

Operations Analyst, Evernorth Accountable Care – Hybrid

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1 Vacancy
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Job Location drjobs

Saint Louis - USA

Monthly Salary drjobs

Not Disclosed

drjobs

Salary Not Disclosed

Vacancy

1 Vacancy

Job Description

Evernorth Accountable Care focuses on partnering with healthcare providers to form value-based care relationships improving care for patients and reducing total healthcare costs. Evernorth Accountable Care is delegated claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers. The Operations Analyst will support various key operational functions related to claim processing claim payment vendor management and operational coordination with payer teams.

Essential Functions

  • Maintaining and managing relationships with claim clearinghouses

  • Serving as a primary liaison to one or more claim payment vendors

  • Developing and maintaining operational processes to investigate and resolve claim inquiries and issues reported by providers payers customer service and internal stakeholders

  • Establishing a close partnership with Evernorth Accountable Care Technology Production Support to identify and triage production issues.

  • Supporting claim adjustments processes including interfacing with teams at payers to ensure claim adjustments opportunities are identified prioritized and processed in an efficient and accurate manner.

  • Supporting any manual intervention needed on claims including late payment interest rules and calculations liens and garnishment application refund requests and more.

  • Work through resolving cases in a claim fallout queue by performing root cause analysis and following standard operating procedure

  • Support business acceptance testing for new technology features that impact claim operations end users.

  • Maintaining processes that require collaboration with various enterprise groups such as Provider Relations; Fraud Waste and Abuse; Accounting; Finance; and more.

  • Supporting the creation and maintenance of standard operating procedures for the claim operations team

Qualifications

  • 2 years of experience in an operations setting required

  • Previous healthcare experience preferred

  • High attention to detail and proven ability to manage multiple competing priorities simultaneously

  • Strong experience working in Excel with knowledge of how to perform VLOOKUPs pivot tables basic functions and basic data analysis

  • Strong critical thinking skills and ability to navigate through ambiguity with limited oversight

  • Enthusiasm and passion to meet operational targets

  • Strong ability to execute through and adapt to change

  • Ability to raise risks and issues to leadership in a fact-based approach leading with a solution proposal

  • Ability to predict challenges and seek to proactively head-off obstacles

  • Proven ability to develop strong working relationships in a cross-functional team environment

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 23 - 35 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. Thats why youll enjoy a comprehensive range of benefits with a focus on supporting your whole health. Starting on day one of your employment youll 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 Group.

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 require reasonable accommodation in completing the online application process please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

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.


Required Experience:

IC

Employment Type

Full-Time

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