CIGNA

Job Location: remoted, work from home, United States SUMMARY: This role is an individual contributor responsible for day-to-day coordination and/or execution of all operating functions required to support new and evolving programs within the CareAllies Project Support Office within the Director of CareAllies Centralized Operations. The role will report directly to the Project Support Office (PSO) Program Manager. Current program responsibilities of this role include but are not limited to operational efficacy, design and document workflow, manages and provides solutions to business units, trends, and concepts appropriately through the latest technological paths, and manages activities related to vendor contract lifecycle. The Business Analysis Lead Analyst understands their customer's business requirements and business process management, and then translates them to particular requirements. RESPONSIBILITIES: Establish a project charter and Scope document for all projects.Collect and...

eviCore Software Engineers build and advance technologies and products leveraged across the organization and healthcare. eviCore is shaping the future of Utilization Management through our advanced platform. We are looking for engineers enthusiastic about solving problems across the full-stack as we continue to push innovation. We are looking for engineers to be versatile, display a passion for leadership and challenge the status quo. In this role you will deliver solutions that align to the end user as a member of a highly autonomous Scrum Team. You will help create solutions and deliver backlog items in support of a multi-data center, active-active, event driven platform that is backed by Kafka. Your contributions will include design and delivery of cloud deployable microservice solutions, as well as platform components and packages for use by other development teams. Primary Responsibilities: Build modern, architecturally sound components, tools and applications. Bring...

Scrum Master-Work from home-eviCore (Information Technology)Remote, Work from home, United StatesOverview:Are you a passionate agile practitioner with experience as a Scrum Master and organizational change agent? Would you like to contribute creatively to a mission as meaningful as transforming healthcare? We are revolutionizing the way that caregivers across the country integrate information and make decisions. Can you help us? eviCore healthcare brings an unprecedented combination of scale, industry-leading technology and creative talent to change the way we experience healthcare. We are a company committed to advancing medical benefits management - and enabling better outcomes for patients, providers, and insurers. We have the size and scale to tackle the complexity of today's and tomorrow's healthcare system.Want to join us?As a Scrum Master, you will routinely wear the hats of facilitator, teacher, coach, and mentor to help enable your product team to develop customer-centric...

**Summary** Directs and coordinates activities for credit team conducting credit investigations, establishing new accounts review and maintain client credit limits, ability to present to senior leadership from a high level perspective representing all credit risks, and files by performing the following duties personally or through subordinates: **Essential Duties and Responsibilities** include the following. Other duties may be assigned. Assigns workers responsibility for investigating and verifying financial status and reputation of prospective customers applying for credit, preparing documents to substantiate findings, and recommending rejection or approval of applications. + Arranges and oversees completion of all work related to maintenance of accounts + Maximizes team's productivity through proficient use of appropriate software applications. + Establishes and updates customers' credit activities. Ability to identify positive and negative changes in a Balance Sheet, Profit and...

Remote, Work from home, United States As a Manager, you'll work as part of a team helping to solve complex business issues, from strategy to execution. This will include engagement in the delivery cycle where you will proactively evaluate and maintain the health of production environments across multiple lines of business. Must have a technology, or engineering background and 3+ years of overall progressive experience managing teams in e-commerce software applications, which includes the following skill sets: Manage and lead application reliability practices based on current production support industry trends for consumer facing experiences Utilizes develop experience to assist the team in resolving issues when needed & accountable for driving production optimization with delivery teams including timely implementation based on need Develop, validate and automate real time monitoring solutions that provide visibility into site health and functional metrics for...

Remote, Work from home, United StatesOverview:Are you a passionate agile practitioner with experience as a Scrum Master and organizational change agent? Would you like to contribute creatively to a mission as meaningful as transforming healthcare? We are revolutionizing the way that caregivers across the country integrate information and make decisions. Can you help us? eviCore healthcare brings an unprecedented combination of scale, industry-leading technology and creative talent to change the way we experience healthcare. We are a company committed to advancing medical benefits management - and enabling better outcomes for patients, providers, and insurers. We have the size and scale to tackle the complexity of today's and tomorrow's healthcare system.Want to join us?As a Scrum Master, you will routinely wear the hats of facilitator, teacher, coach, and mentor to help enable your product team to develop customer-centric software products from idea to production. The candidate...

Financial Analysis Senior Supervisor- Work from Home- Express Scripts (Finance) Summary Directs and coordinates activities for credit team conducting credit investigations, establishing new accounts review and maintain client credit limits, ability to present to senior leadership from a high level perspective representing all credit risks, and files by performing the following duties personally or through subordinates: Essential Duties and Responsibilities include the following. Other duties may be assigned.Assigns workers responsibility for investigating and verifying financial status and reputation of prospective customers applying for credit, preparing documents to substantiate findings, and recommending rejection or approval of applications.Arranges and oversees completion of all work related to maintenance of accountsMaximizes team's productivity through proficient use of appropriate software applications.Establishes and updates customers' credit activities.Ability to identify...

Collections and Billing Sr Representative BC/BS Collections DepartmentJob SummaryHelp us support our future. Get ready for a job that encourages you to think strategically yet stay connected with your teams. Do you have problem-solving or customer service experience? If so, prepare to innovate, create, and inspire.The Collections and Billing Sr. Representative provides straightforward administrative and/or other basic business services in Collecting/Billing. Provides financial related support for banking and/or billing related functions to new and/or existing accounts.About CignaCigna is a global health service company dedicated to helping the people we serve improve their health, well-being, and peace of mind. But we dont just care about your well being, we care about your career health too. Thats why when you work with us, you can count on a different kind of career youll make a difference, learn a ton, and share in changing the way people think about...

Responsible for selling activities related to new business development, home appointments, group presentations, and provider/community collaboration for Medicare-related products. RESPONSIBILITY:Meet or exceed sales quotas, compliance requirements, a Field, Sales, Representative, Remote, Bilingual, County, Insurance, Business Services

This position serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management of the day to day contracting and network management activities for a local given territory. DUTIES AND RESPONSIBILITIES Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups). Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy. Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service. Manages strategic positioning for provider contracting, develops networks and...

Operations Senior Analyst - Work from home (Finance) **Work from home opportunity Have you heard? Express Scripts is now part of Cigna. Together, we've got big plans. How big, you ask? We want to change health care to make it more affordable, more personalized, and more focused on helping the whole person to achieve better health outcomes. And that's only the beginning. Read on to learn more about working with us. Position Summary: As an Operations Sr Analyst, you will be working on a team building and maintaining custom client prior authorization portfolios. You will work independently while also backed by a phenomenal team of analysts and pharmacists focused on providing exceptional service to our clients. Here's how you'll make an impact: Responsible for service transactions associated with business needs including but not limited to: client support, product support, and internal team support (projects/training) Complete day-to-day Business Operations...

***Virtual - Must live within 100 miles of Dublin OH*** As a Customer Service Representative , you'll assist our members by managing inbound and outbound calls to expedite home delivery of their prescription medication. You'll also help them to better understand why our offerings fit their lifestyle, upselling our services to customers where appropriate. This role is on the front lines with patients and doctors' offices, addressing customers with care, detail, and most importantly, empathy. This isn't your typical Customer Service role . In fact, we have a few perks up our sleeves. For starters, we offer four weeks of paid training, performance-based monthly bonuses and the opportunity for advancement after only 12 months of employment. (Did we mention our yearly competitive, yet friendly pumpkin decorating contest? It's epic.) How You'll Make A Difference: Help patients better understand the Home Delivery benefit. Use your expert knowledge and consultative sales...

Note: Remote Work from home United States Member of the Special Investigations Analytics team that works closely with other analysts, investigators, advanced IT specialists, and management. The primary responsibility of the position is to apply statistical analysis and modeling on datasets to identify fraud, waste and abuse cases and trends. The role effectively integrates knowledge of data analysis, statistics, data science tools and related analytical software. Works closely with peers to test analytical models for accuracy. Conducts a comprehensive review to identify highly suspect billing behaviors and trends, potential overpayments and formulates specific investigative next steps. Utilize creative thinking skills to identify new avenues to gather information and evidence to ultimately mitigate patient harm and financial risk to our clients, and customers. Responsibilities Facilitate comprehensive data mining programs utilizing multiple analytical and database...

Summary The Senior Sales Advisor - Workers Compensation is primarily responsible for managing complex prospect strategies within the assigned territory and ensuring sales goals are met through the development of new business. The Sales Executive educates prospective customers on Workers Compensation PBM, the market environment, and the interactions with claims payers. This person works closely with Marketing, Clinical Team, Product, and Operations staff to ensure our tradition of excellent customer service. Additionally, they will respond to RFP's, deliver a compelling price and service proposal, manage capabilities and finalist presentations, and demonstrate prospecting discipline. The position offers the option of a Virtual/Remote working environment. Essential Functions Meet sales objectives in individual territory. Responsible for meeting sales goals as defined. Meet productivity requirements with regard to quality prospect interaction. Monthly goals for outreach...

Location: WAH but will travel to CMG clinics as needed. Job Summary: The Virtual Care Team Member is an integral part of the overall patient's journey. This role provides ongoing support and follow-up to the patient population served beyond the walls of the physician's office. The Virtual Care Team Member serves as point of contact for patients, medical providers, and clinic staff and is a patient advocate who ensures excellence in the patients experience in their Virtual Care visit. This role is critical to the success of Cigna Medical Group's virtual footprint, consistent with broader strategic goals, and for driving patient volume through telehealth channels. Role Facilitate Virtual Care visits by proactively working with patients to help them successfully activate MyChart and educate them on steps needed for a Virtual Care visit with their medical provider Provide timely telephonic support and documentation of Virtual Care visits Maintain on-going communication and...

Remote, Work from home, United States This position will be responsible for performing the daily tasks of delegation oversight, including selection and retention of practitioner/provider group accounts that are seeking or have been awarded delegated credentialing for the Behavioral, Dental, and Medical line of businesses. Conduct practitioner/provider group credentialing audits for initial, annual and interim assessments in accordance with Cigna and CMS regulatory requirements. Negotiate and manage delegation contractual agreements. Be a key contributor for internal and external organization audits. Analyze and manage delegated practitioner/provider data. Maintain working knowledge of regulatory credentialing requirements as applicable for medical, dental and behavioral delegation. Collaborate effectively with delegated groups, compliance/legal, direct credentialing, contracting, and other matrix partners, as applicable. Maintain fundamental understanding of key matrix partners'...

JOB SUMMARY The Agile Product Advisor represents the "voice of the customer" at the team level, maintaining and prioritizing the Product Backlog, to ensure that the team is working on stories that maximize business value and deliver necessary fixes and functionality to all customers. They must have strong business skills and experience, with either some past experience working with technology teams, or the ability and interest to learn how to work with technology teams. As a Business Product Owner, this position will be accountable to the Operational leaders in PBM Services for driving transformational IT Product initiatives to help deliver strategic solutions and ensure product health and stability. The role will be primarily responsible for the automation of client benefits. Solicitation of requirements from the business and clients will be crucial for success. This person will drive the business strategies into prioritized initiatives for the IT teams along with our...

Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. We are seeking experienced Product Owners to join our Affordability Solution team. This Product Owner will oversee a specific cross-cutting enabler and/or solution in support of multiple Affordability opportunities. Examples of cross cutting enablers and solutions include: telephonic care navigation and onboarding, opportunity and message prioritization, customer health profile and need identification and referral capabilities (other spaces will emerge as we push our affordability strategy and execution work forward). The Product Owner will work to understand the key needs dictated by the Affordability Strategy and the Opportunity Team. Once...

Credentialing Lead Analyst - Work from home (Finance) Remote, Work from home, United States This position will be responsible for performing the daily tasks of delegation oversight, including selection and retention of practitioner/provider group accounts that are seeking or have been awarded delegated credentialing for the Behavioral, Dental, and Medical line of businesses. Conduct practitioner/provider group credentialing audits for initial, annual and interim assessments in accordance with Cigna and CMS regulatory requirements. Negotiate and manage delegation contractual agreements. Be a key contributor for internal and external organization audits. Analyze and manage delegated practitioner/provider data. Maintain working knowledge of regulatory credentialing requirements as applicable for medical, dental and behavioral delegation. Collaborate effectively with delegated groups, compliance/legal, direct credentialing, contracting, and other matrix partners, as applicable....

Note: Remote Work from home United States Member of the Special Investigations Analytics team that works closely with other analysts, investigators, advanced IT specialists, and management. The primary responsibility of the position is to apply statistical analysis and modeling on datasets to identify fraud, waste and abuse cases and trends. The role effectively integrates knowledge of data analysis, statistics, data science tools and related analytical software. Works closely with peers to test analytical models for accuracy. Conducts a comprehensive review to identify highly suspect billing behaviors and trends, potential overpayments and formulates specific investigative next steps. Utilize creative thinking skills to identify new avenues to gather information and evidence to ultimately mitigate patient harm and financial risk to our clients, and customers. Responsibilities Facilitate comprehensive data mining programs utilizing multiple analytical and database...