Claims Lead Representative – Evernorth Payer Solutions – Remote Job 2024 Full Time

Claims Lead Representative for Cigna LifeSOURCE (aka NAC Claims Repricer)

Role Summary: Examines and reprices paper and electronic claims for Network Access Client (NAC) business for the Cigna LifeSOURCE Transplant Network. Determines steps necessary for repricing. Ability to understand and apply LifeSOURCE contract terms and rates, as well as individual Letters of Agreements, to claims and reprice accurately. Preferably 5 years experience in claims processing. Responsible for independently reviewing complex, specialty claims. Works closely with LifeSOURCE Transplant Care Coordinators (nurses).

Responsibilities:

• Reprice claims for growing NAC business for Cigna LifeSOURCE network meeting turnaround times of 5 business days, 95% procedural accuracy and 98.5% financial accuracy

• Be able to understand and apply the various provisions and rates from 160+ LifeSOURCE contracts

• Determine if claims are transplant or non-transplant related, appropriate zone and apply correct rates from LifeSOURCE contract

• Research and review claims issues, working with providers, payers, contracting team and NAC nurse coordinators to resolve

• Participate on conference calls as needed for any escalated issues

• Work closely with LifeSOURCE nurse coordinators to determine zones as well as transplant related and non-transplant related claims

• Respond to telephonic and e-mail claims inquiries from clients and providers

• Provide support, as needed, to other teams within Payer Solutions including medical/dental claim pricing, correspondence, etc.

• Other duties as assigned

Qualifications:

• 3+ years experience in claims processing and adjudication with experience in inpatient, outpatient hospital and professional claims

• Transplant claims experience a plus

• Strong verbal and written communication skills

• Working knowledge of Excel

• Strong analytical and problem solving skills

• Highly motivated, self-starter with ability to work independently and as a team to achieve goals and objectives

• Ability to work with providers, contracting, account managers, nurse coordinators and clients to resolve claims issues

• Ability to understand transplant provider contracts, interpret contract language and rate provisions

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 21 – 32 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 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.