Job Summary:

The Claims Payment Integrity Operations Advisor will play an important role in our Affordability strategy by providing claim payments oversight for the Individual and Family Plans (IFP) segment. This role will apply analytical, technical and leadership skills to monitor payment integrity focus areas to identify opportunities and drive implementation of solutions to prevent overpayments, penalties, and ensure administration is consistent with plan benefits. This individual will work closely with Claim Operations, Clinical Utilization Management partners, Product, IFP's Total Cost of Care team and other matrix partners.

The role is designed for an individual who enjoys the challenge of working in a fast-paced environment with the ability to influence and prioritize key deliverables for success.

Core Responsibilities:

• Establish reports to monitor and analyze results for leakage
  
  


• Help create solutions and drive delivery of solutions to prevent claim overpayments, unnecessary claim spend, and ensure timeliness and accuracy of claim administration.
  
  


• Have an excellent grasp of the claims system and overall workflow
  
  


• Become well-acquainted with internal tools and technical processes, and develop insights into improvement opportunities
  
  


• Become an in-house expert on all claims-related matters required to resolve payment integrity cases and provide escalation support to the claims processing team
  
  


• Provides insight for new claim scenario creation, validation, deployment, and monitoring.
  
  


• Facilitate Claims Monthly Operating Review
  
  


• Facilitate monthly Claims Accuracy and Payment Integrity workgroup to including data analysis, troubleshooting and issue resolution.
  
  


• Represent IFP during the weekly High Dollar Panel Review and participate in Claim SQRM sessions to identify root causes and improvement actions.
  
  


• Monitor overpayment recoveries to ensure high collection rates and for leakage prevention opportunities.
  
  

Minimum Qualifications:

• Bachelor's Degree preferred or minimum of 5 years healthcare/health insurance (3 years in health care/health insurance in an operations area to include 2 years in Claims operations and analysis experience such as root-cause analysis, impact analysis and regression)
  
  


• Claim coaching experience preferred
  
  


• Expertise in end-to-end claims operations and processes, particularly Cigna's Facets operations for IFP.
  
  


• Deep knowledge of claims and upstream and downstream impacts.
  
  


• Knowledge of claims coding, regulatory rules and medical policy.
  
  


• Project design, management, and implementation experience.
  
  


• Knowledge of continuous improvement fundamentals.
  
  


• Ability to effectively identify and help resolve issues and risks.
  
  


• Ability to manage and help resolve conflicting points of view.
  
  


• Excellent written and oral communication skills.
  
  


• Good analytical and problem solving skills, including the ability to interpret and present quantitative data.
  
  


• Ability to prioritize and effectively manage deliverables.
  
  

This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.