Plan Implementation Sr. Representative - Evernorth - Remote

The Sr. Representative is responsible for CIM Data and Demographics such as Demo Changes and Fall out, along with LXNX and other issues that arise with provider data. Providing back up to the different team. Learning all the nuances for our National Providers. Provide recommendations for process improvements and elimination of barriers, obstacles and risks and assists with delivery and implementation of solutions using our nuances and various tools for the National Ancillary Team.

Responsibilities

• Perform tasks such as research fall out issues
• Work any work items that come to your box
• Follow up with the manager on infractions monthly.
• Able to understand the interdependence among business systems, teams and matrix partners; recognizes when changes or additional analysis needs to be conducted and provide appropriate feedback and suggestions.
• Participate in peer training and coaching support to obtain required processing knowledge.
• Participate in workload balancing daily as needs arise to support work streams and functions
• Understands and supports the team as needed.
• Understand and follow all loading instruction, policy and procedure documentation. Continually identify and escalate process gaps and opportunities for process efficiencies across documentation to avoid negative customer impacts.
• Initiate accurate problem identification and present root cause analysis findings utilizing appropriate data trending tools and resources. Collaborate to implement corrective actions.
• Meet deadlines and accept additional tasks and assignments while maintaining established quality, production, and team timeliness standards.
• Able to work successfully in a team environment as well as one your own.
• Able to work and collaborate with matrix partners to provide regular data performance feedback, close data integrity gaps and proactively seek resolutions.

Qualifications

• Associate's degree or higher strongly preferred or equivalent work experience required.
• Prior experience in the healthcare industry and knowledge of medical terminology (or any combination of education and work experience) preferred.
• Knowledge of Microsoft Word, Excel and Access.
• Preferred knowledge of HCPM required.
• Facets and Proclaim are preferred.
• Prior claim exposure/experience preferred.
• Preferred, working knowledge of, and/or experience with coding and reimbursement methodologies.
• Prior experience with provider data loading preferred. Understand how contracts are set up and current business policies and technology will affect claim payment.
• Proven ability to maintain positive working relationships, receiving and providing feedback, coaching and guidance to/from other staff members
• Self-starter with proven technical, analytical, negotiating, problem-solving, organizational and time management skills. Self-motivated, detail oriented, decisive, and adaptable to change
• Aptitude in demonstrating the ability to maintain a high level of focus and attention to detail while working with complex data and systems
• Ability to function well in a fast-paced, demanding environment
• Must be able to effectively communicate across a wide variety of topics to various audiences.
• Ability to work independently while managing multiple tasks and meeting deadlines while also being a strong team player, partnering with others to collaboratively resolve issues and deliver solutions

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 25 - 37 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.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll 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 The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. 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.