United States onlyQuality Assurance Claims Systems Auditor, Senior Analyst
Are you passionate about driving growth and improving lives?
EviCore, a division of The Cigna Group is seeking a Quality Assurance Claims Systems Auditor, Senior Analyst. In this critical role, you’ll audit all contract details loaded into our claims systems, ensuring the highest standards of accuracy and quality. As a senior-level professional, you will independently navigate all aspects of our claims systems and processes, ensuring data integrity, security, and process optimization for EviCore's claims processing.
What you’ll do to make a difference:
o Review and analyze provider contracts to ensure compliance with company policies and regulatory requirements
o Verify the accuracy of data entered into claims systems, identifying and rectifying discrepancies
o Collaborate with various departments to ensure accurate and timely data entry and contract implementation
o Provide constructive feedback and recommendations to improve data accuracy and contract management processes
o Develop and maintain documentation related to contract reviews and data accuracy checks
o Assist in the development and implementation of training programs for staff related to contract management review and data entry.
How you’ll be a success:
o High school diploma or GED required, Bachelor’s Degree in Business Administration, Healthcare Management, or a related field, preferred
o Strong analytical skills and attention to detail preferred
o 3+ years of experience in Claims Systems Configuration / editing, ICD-10, CPT Coding, Claims adjudication and payment and Manual intervention with claims systems, required
o Proficiency in Microsoft Office products, required
o Proficiency in using claims management systems and data analysis tools preferred
o Experience with Plexis preferred
o Experience with MedSuite preferred
o Knowledge of the claims lifecycle, required
o Understanding of Project Management methodologies, preferred
o Strong communication (written and oral) skills and interpersonal skills preferred
o Ability to work independently and as part of a team preferred
o Strong problem-solving skills and the ability to provide constructive feedback preferred
o Familiarity with provider reimbursement methodologies and healthcare billing practices preferred
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.
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: [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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
