Plan Implementation Sr. Representative - Evernorth - Remote

Summary
Manages provider demographic and reimbursement data for Client Specific Networks.

Reports to client contacts and collaborates with internal teams to ensure accurate provider systems for claims and directories.

Supports Provider Loading projects as needed.

Responsibilities


* Load and configure system applications for managed care contracts.


* Maintain and update client-specific network data.


* Manage network maintenance tasks.


* Interpret and apply CSN contracts using appropriate tools.


* Partner with Business Intelligence to automate networks and resolve claim issues.


* Perform root cause analysis and resolve issues using internal resources.


* Ensure provider data accuracy and network quality.


* Investigate and resolve claim issues.


* Audit data for system alignment and integrity.


* Lead process improvements and automation initiatives.


* Communicate demographic and reimbursement setups to matrix partners.


* Identify workflow improvements and volume reduction opportunities.

Qualifications


* High school diploma or GED required.


* 1+ years of experience working with managed care data systems and claims applications (Ex.

Proclaim and/or HCPM) highly preferred.


* Experience with account management/handling a book of business is highly preferred.


* Strong technical, analytical, and decision-making skills.


* Proficient in Microsoft Office (Excel experience using pivot tables and VLOOKUPs is highly preferred)


* Able to manage multiple tasks independently.


* Accurate data management and strong communication skills.

Competencies


* End-to-end process knowledge


* Critical thinking


* Prioritization


* Organization


* Responsiveness


* Clear communication


* Customer focus

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 24 - 37 USD / hourly, depending on relevant factors, including experience and geographic location.

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

We want you to be healthy, balanced, and feel secure.

That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.

We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

For more details on our employee benefits programs, visit Life at Cigna Group .

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of li...