Claims Analyst, Team Lead - Evernorth Health Services - Remote

Claims Analyst - Team Lead

Responsibilities:


* Responsible for the technical development and support for a team of claim processors:


* Provides support for questions; timely, efficient, accurate responses


* Supports, educates and reinforces the consistent claim process flow


* Provides individual and/or group coaching and development


* Facilitation of training delivery for specified current and/or new information


* Supports the Service Quality Review Meeting (SQRM) process for trends and root cause identification; provides backup support to auditor


* Supports and drives process improvement to further enhance claim accuracy outcomes


* Accountable for the team's overall quality results


* Engagement, partnership with manager, auditor, and claim processing team; team huddles, team meetings, service strategy


* Participates in system release reviews and check outs.


* Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams.


* Identifies steps necessary to process a varying complexity of contracts for pricing accuracy


* Researches, analyzes and calculates claims in accordance with provider contracts


* Works with internal matrix partners to resolve pended claims issues


* Other duties as assigned

Qualifications:


* 5 years plus of LifeSource claim processing technical knowledge and application


* Customer Service Driven; ability to meet and exceed the internal partner and external customer expectations


* Take accountability in critical thinking and decision making outcomes


* Problem solving skills; utilization of technical skills and resources to ensure accuracy of final claim resolution


* Strong communication skills, both verbal and written


* Ability to teach, educate, coach others through a variety of claim complexities


* Process improvement skills; ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions


* Fluent understanding and application of key tools and resources for claim processing; KnowledgeXchange, Calculators, CPF/PWB, LRCM, PCRS, etc.


* Comfortable working with others in multiple locations; office and work at home


* Position requires excellent interpersonal skills; ability to understand and interpret policy provisions, and to present report analysis and meaningful findings in a clear, concise way.


* Basic knowledge with Word, Excel, PowerPoint, WebEx and Outlook 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.

For this position, we anticipate offering an hourly rate of 23 - 35 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an...