Manager Claims Systems EviCore

The Manager of Claims Systems will own process design tactical implementation and execution of strategies within the Claim Systems and Configuration teams through delegation or personal execution. The position oversees the day-to-day operations with ultimate responsibility for the successful completion and quality of claims systems deliverables. This position will perform duties under self-direction have decision making responsibilities and act under the supervision of and assist the Sr Manager of Claims Systems as needed.

Primary duties include but are not limited to:

• Oversight of Claims Systems initiatives change control risk assessment/management impediment removal as well as progress reporting to the Director of Claims Systems and/or other leadership as required.
• Collaborate with the Claims Business Process Solutions Claims Business Intake Team and Claims Product and Planning team for claims backlog governance workflow input process improvement initiatives and resource impediments solutions.
• Provide input as needed toward LBC and OC discussions with Claims Leadership and Product and Planning resources.
• Through personal execution or delegation ensure creation/maintenance of departmental work instructions policies and workflows required to ensure success of deliverables and transition of knowledge to team members and other internal departments.
• Provide final approval of department work instructions policies workflows and training as well as ensure audits are performed to verify adherence is met appropriately and timely.
• Motivate and guide the department to meet and exceed all goals and objectives as set forth by leadership.
• Support team Supervisors and Trainers regarding knowledge growth (i.e. platform program process etc.).
• Support team Supervisors in personnel activities (i.e. time and attendance recruitment annual performance evaluations payroll disciplinary procedures training etc.).
• Oversight of departmental audit control maintenance adherence to audit controls and audit control artifacts are accessible upon request through collaboration with the Compliance team.
• Provide support to Claim Systems resources to overcome knowledge impediments or client escalations which the Trainer and Supervisors are unable to overcome through appropriate channels of support available both internally and externally.

Minimum Education Licensure and Professional Certification requirement: High School Diploma required Bachelors degree preferred.

Minimum Experience Required:

• 5 years of healthcare claims life cycle and client/vendor relationship experience with an emphasis in healthcare claims system configuration/implementations.
• 2 years of supervisor experience

Skills:

• Proficient in Excel Word and Access required.
• Knowledge of SQL data query.
• Experience in claims adjudication platform maintenance and implementation required.
• Experience in Business Quality Assurance processes required.
• Commitment to expand knowledge of claims adjudication platform and supportive systems in accordance with initiative/request needs.
• Knowledge of Agile and Kanban required.
• Knowledge of Jira board and dashboard management a plus.
• Strong analytical and critical thinking skills required.
• Strong decision-making skills required.
• Strong aptitude for process improvement required
• Strong communication skills required
• Ability to supervise multitask and work independently in a fast-paced environment are essential skills for this position

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group 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) 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 click here.

About Evernorth Health Services

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.