Quality Assurance Claims Systems Auditor, Senior Analyst - EviCore - Remote

Quality 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, colo...