Cigna
Transplant Benefit Analyst/Case Management Analyst - Evernorth Health Services (Finance)
Responsibilities:
Review eligibility, liability, and coverage information on new cases and on regularly scheduled follow-up; provide communication of benefit plans for cases on an as-needed basis; periodically update this information
Review and direct claim payment for cases that have a treatment plan in place, and that are being managed by the coordinators.
Consult on cases moving into management regarding treatment plan funding based on case management philosophy. Periodically review cases during management according to guidelines.
Research and analyze insurance, claim payment and nonpayment issues and problems.
Provide insurance training for new personnel and conduct insurance in-service programs as needed.
Adheres to quality assurance standards and all case management policies and procedures, especially those related to confidentiality
Adheres to productivity and workload management goals and accurately reports
Accurately and timely assessment of provider's contract to determine coverage and benefit availability
Communicates professionally with all internal and external customers, peers, matrix partners.
Qualifications:
High School diploma or GED required.
5+ years of progressive movement within group health insurance positions preferred.
2+ years of customer service experience required.
Excellent knowledge of group health benefit plans preferred.
Good analytical, evaluation, organizational and communication skills.
Ability to clearly communicate information to case managers using case management applications.
Working knowledge of medical terminology.
Ability to work independently and make independent decisions and ability to work unsupervised on special projects.
Ability to adapt to a high volume environment and work within a fast-paced dynamic environment.
Ability to function as part of a team.
Solid time management skills
Demonstrated ability to participate on/lead projects and workflow improvement initiatives.
Ability to act as change agent to support organization's objectives.
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 - 34 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.
Qualified applicants with criminal histories will be considered for employment in a manner
consistent with all federal, state and local ordinances.
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.