Job Information
The Cigna Group Claim Operations Senior Manager - Evernorth Accountable Care - Hybrid in Scottsdale, Arizona
Position Summary
Evernorth Accountable Care is a new business focused on partnering with healthcare providers to form value-based care relationships, improving care for patients and reducing total healthcare costs. Evernorth Accountable Care will be delegated select claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers. In support of the launch of the claims processing capabilities, Evernorth Accountable Care is seeking an experienced Claim Operations senior leader to build a high performing team of claim analysts and operations personnel to support the business in ongoing claim operations.
Essential Functions
The Senior Manager of Claim Operations will oversee a team of 3-15 team members (combination of FTEs and contractors) that includes the following responsibilities:
Maintaining and managing relationships with nine 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 operational processes in support of a close partnership with Evernorth Accountable Care Technology Production Support
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.
Overseeing and managing a queue for reviewing and resolving claim fallout.
Partnering with Evernorth Accountable Care’s claim product management organization to inform requirements for technology enhancements that support the growth of the business.
Support business acceptance testing for new technology features that impact claim operations end users.
Establishing and maintaining processes that require collaboration with various enterprise groups, such as Provider Relations; Fraud, Waste, and Abuse; Accounting; Finance; and more.
Regularly communicating and presenting on the overall health of Evernorth Accountable Care claim operations to sr. leadership
Creating and maintaining standard operating procedures for the claim operations team
Providing onboarding and training to new team members
Qualifications
Bachelor’s Degree or equivalent work experience required
Previous healthcare claims experience required
5+ years of experience in an operations setting required
3+ years of leadership experience in an operations setting required
Proven ability to build, develop, and motivate high performing teams in a fast paced, high impact operations environment
Ability to delegate work in a manner that maximizes the strengths, skillsets, interests, and growth opportunities of the team
Experience establishing new operational processes and/or leading teams through a new initiative launch within a highly matrixed organization
Enthusiasm and passion to meet operational targets
Strong ability to navigate, communicate, and lead others through a high degree of change
Strong critical thinking skills and ability to navigate through ambiguity with limited oversight
Ability to predict challenges and seek to proactively head-off obstacles
High attention to detail and proven ability to manage multiple, competing priorities simultaneously
Experience preparing and delivering monthly operating review presentations to sr. leaders
Proven ability to develop strong working relationships and establish a high level of credibility across teams and lines of business
Periodic travel required
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 annual salary of 111,500 - 185,900 USD / yearly, 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 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, 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.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
The Cigna Group
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