Job description

eviCore is currently hiring a Claim Repricing Process Advisor. The Claim Repricing Process Advisor supports the Process Management of a strategic program by providing central expertise, governance, and controls within the Claims Operations Department. Process Management Advisor will focus on process outcomes, throughput yield, process defect identification and resolution, process improvements, cost per unit/value, waste elimination, process flows, client integration, and value based change requests and system capabilities. The Claim Repricing Process Advisor is responsible for the end-to-end process of the eviCore Repricing claims business for timeliness and quality across the eviCore network. In this role, you will interface with a variety of business partners, senior leadership, and external vendors. A successful candidate in this role will have experience in driving process improvement; maximize business value and achieving results.

RESPONSIBILITIES:
Plans, documents and executes all phases of the process improvement lifecycle for eviCore Repricing Claims Business including scope, requirements, TTP Metric adherence, timeline management, priority and dependency management, and the assignment of roles and responsibilities.
Participates in and/or facilitates the design, development, and implementation of new operational controls, performance metrics, information management systems, enhancements, and automated processes.
Partners with IT, Systems, Project/Client Managers and Product and Planning to coordinate solution delivery, tracking progress for delivery of necessary functionality to all customers, and raising risks to Leadership and Project teams
Leads the weekly or bi-weekly stakeholder meeting with the client teams and leadership to discuss project status
Promotes change, process and best practices with business partners and IT team members including documentation of process workflows and training of department heads on changes to support departmental policy/procedure updates required
Maintains and controls the single source of truth for all Repricing Workflows and File Exchange catalog including the supporting business requirements
Partners with the Systems and Configuration teams and is a key resource during Implementations or Change Requests to ensure Repricing processes are updated, tested, and operating as expected per requirements.
Partners with the Compliance team actively addressing any compliance issues that involve Repricing claim concerns.
Interface with clients as needed for projects, issue resolution and reporting.

QUALIFICATIONS:
Bachelor’s degree preferred OR equivalent work experience will be considered in lieu.
7+ years of medical claims processing and transaction experience
A Certified Product Owner (CPO) preferred.
Ability to confidently present data and information to executive leaders
SQL experience
837 and 835 X12 experience in triage/mapping
Strong experience with billing rule policies, e.g., CCI, MPPR, MUEs, ICD-10 base.
Experience creating test plans and end user testing.
Successful in building and maintaining internal business partnerships/ relationships.
Process Improvement experience required.
Excellent written and oral communication
External client relationship experience
Ability to gain consensus amongst diverse stakeholders.
Ability to coordinate and prioritize multiple initiatives.

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 89,500 - 149,100 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.

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