Operations Analyst, Evernorth Accountable Care - Hybrid

Evernorth Accountable Care focuses on partnering with healthcare providers to form value-based care relationships, improving care for patients and reducing total healthcare costs.

Evernorth Accountable Care is delegated claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers.

The Operations Analyst will support various key operational functions related to claim processing, claim payment, vendor management, and operational coordination with payer teams.

Essential Functions


* Maintaining and managing relationships with claim clearinghouses


* Serving as a primary liaison to one or more claim payment vendors


* Developing and maintaining operational processes to investigate and resolve claim inquiries and issues reported by providers, payers, customer service, and internal stakeholders


* Establishing a close partnership with Evernorth Accountable Care Technology Production Support to identify and triage production issues.


* Supporting claim adjustments processes, including interfacing with teams at payers to ensure claim adjustments opportunities are identified, prioritized, and processed in an efficient and accurate manner.


* Supporting any manual intervention needed on claims, including late payment interest rules and calculations, liens and garnishment application, refund requests, and more.


* Work through resolving cases in a claim fallout queue by performing root cause analysis and following standard operating procedure


* Support business acceptance testing for new technology features that impact claim operations end users.


* Maintaining processes that require collaboration with various enterprise groups, such as Provider Relations; Fraud, Waste, and Abuse; Accounting; Finance; and more.


* Supporting the creation and maintenance of standard operating procedures for the claim operations team

Qualifications


* 2+ years of experience in an operations setting required


* Previous healthcare experience preferred


* High attention to detail and proven ability to manage multiple, competing priorities simultaneously


* Strong experience working in Excel with knowledge of how to perform VLOOKUPs, pivot tables, basic functions, and basic data analysis


* Strong critical thinking skills and ability to navigate through ambiguity with limited oversight


* Enthusiasm and passion to meet operational targets


* Strong ability to execute through and adapt to change


* Ability to raise risks and issues to leadership in a fact-based approach, leading with a solution proposal


* Ability to predict challenges and seek to proactively head-off obstacles


* Proven ability to develop strong working relationships in a cross-functional, team environment

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber opt...