Log In
Sign Up
Job Description
Role is within Payment Integrity (Medicare and Commercial Coordination of Benefits Operations and Enhancements).
This position s directly to the teamxe2x80x99s Operations Manager as a key contributor.
RESPONSIBILITIES:
The Medicare and Coordination of Benefits Operations Lead Analyst fulfills the following duties:
Utilizes Medicare expertise in conjunction with strong analytical and collaboration skills to partner with matrix partners and vendors ensuring accurate and timely benefit primacy determination in complex scenarios.
Communicates effectively with Cigna’s vendor partners to assist them in maximizing post payment recovery efforts.
Responds timely to complex share point inquiries (Intake application).
Analyzes weekly/monthly vendor management ing for accuracy and assists with Cignaxe2x80x99s determination as primary or secondary payer in complex situations.
Provides comprehensive feedback and recommendations to client services to assist them with understanding impact of implementing client non-standard elections.
Analyzes ing data for trends within the share point intake application to identify performance or educational areas of opportunity.
Partners effectively with claim, call and client technical coaches to address primacy determination quality trends and efficiency improvement opportunities. Proactively engages with matrix partners (including legal) and vendors to educate when new laws impacting primacy are enacted.
Reviews/analyzes Knowledge Xchange articles to ensure team and vendor adherence.
Responds to requests for access to COB Smart portal and trouble shoots access issues within portal.
Participates in projects to support business initiatives.
QUALIFICATIONS
Bachelor’s degree or higher strongly preferred or equivalent work experience required.
2+ years of work experience with Medicare and coordination of benefits primacy rules required.
Strong knowledge/experience in PROCLAIM, CED, Vipr.
Ability to work collaboratively within team as well as with matrix partners and outside vendors.
Strong analytic and problem-solving skills.
Proficiency in MS Office products such as Word, Outlook and Excel (experience with pivot tables/VLOOKUP) preferred.
Ability to recognize and respond to issues with the appropriate sense of urgency, escalating problems as appropriate.
Excellent communication skills to include written, oral and group presentation skills.
Strong time management skills.
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 61,200 – 102,000 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.
We want you to be healthy, balanced, and feel secure. Thatxe2x80x99s why youxe2x80x99ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, youxe2x80x99ll 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 .
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, wexe2x80x99re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: [email protected] for support. Do not email [email protected] 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.
