28 jobs found

Title: High Band 4 Counsel: Senior Contributor Track Cigna Legal Role Summary: This Counsel role will assist in developing and providing strategic legal advice relating to Cigna's cost containment programs, out-of-network strategy, and Special Investigations Unit. This role will be responsible for researching and analyzing legal questions and risks to facilitate the development and presentation of strategic advice and counsel to matrixed partners across the Cigna enterprise, including stakeholders in business, legal, and regulatory roles. Successful candidates will be able to work collaboratively with multiple partners and harmonize objectives; communicate complex concepts and ideas with clarity and precision to legal and non-legal personnel; possess superior listening skills and be open to understanding and synthesizing multiple points of view; and demonstrate an ability to think creatively and strategically to anticipate business needs and mitigate potential risks....

Claims RepresentativesHelp our customers maintain their health, well-being and sense of security by ensuring medical claims are processed accurately and timely while protecting the confidentiality of our customer's personal health information. Under direct supervision performs duties relating to the claims adjudication process from review of the claim form, verification of eligibility, verification of coordination of benefits with insurance carriers, and finalizing based on the health benefits plan. Technical advice and assistance will be provided by Technical Coaches.ResponsibilitiesReview claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.Follows established policies and procedures to pay, pend for additional information, or deny claims.Adapt to and positively influence change by accepting feedback with a growth mindset to continuously improve.Follow processes and work...

[Call Center / Fully Remote] - Anywhere in U.S. / Up to $18 per hour + bonuses / Health, dental, vision, and life / PTO / 401k match / Equipment provided - As a Customer Service Rep you'll: Handle inbound calls and facilitate outbound calls from/to patients inquiring about their home delivery benefit; Explain the advantages of home delivery prescription services (mail order); Accurately complete and document patient interactions and transactions in company databases; Advocate for the member patient by placing phone calls, fax or other means to physician's office to obtain prescriptions and forward to pharmacy for fulfillment...Hiring Fast >>

[Call Center / Fully Remote] - Anywhere in U.S. / Up to $18 per hour + bonuses / Health, dental, vision, and life / PTO / 401k match / Equipment provided - As a Customer Service Rep you'll: Handle inbound calls and facilitate outbound calls from/to patients inquiring about their home delivery benefit; Explain the advantages of home delivery prescription services (mail order); Accurately complete and document patient interactions and transactions in company databases; Advocate for the member patient by placing phone calls, fax or other means to physician's office to obtain prescriptions and forward to pharmacy for fulfillment...Hiring Fast >>

[Call Center / Fully Remote] - Anywhere in U.S. / Up to $18 per hour + bonuses / Health, dental, vision, and life / PTO / 401k match / Equipment provided - As a Customer Service Rep you'll: Handle inbound calls and facilitate outbound calls from/to patients inquiring about their home delivery benefit; Explain the advantages of home delivery prescription services (mail order); Accurately complete and document patient interactions and transactions in company databases; Advocate for the member patient by placing phone calls, fax or other means to physician's office to obtain prescriptions and forward to pharmacy for fulfillment...Hiring Fast >>

[Call Center / Fully Remote] - Anywhere in U.S. / Up to $18 per hour + bonuses / Health, dental, vision, and life / PTO / 401k match / Equipment provided - As a Customer Service Rep you'll: Handle inbound calls and facilitate outbound calls from/to patients inquiring about their home delivery benefit; Explain the advantages of home delivery prescription services (mail order); Accurately complete and document patient interactions and transactions in company databases; Advocate for the member patient by placing phone calls, fax or other means to physician's office to obtain prescriptions and forward to pharmacy for fulfillment...Hiring Fast >>

B2B Marketing Campaign Analytics Advisor Job Description The Campaign Analytics Advisor is responsible for creating end-to-end B2B campaign analytics and measurements solutions (data sourcing, data visualization and advanced analytics) across U.S Commercial Marketing: Broker, acquisition, retention, market conditioning and cross-sell. The Advisor will provide a clear vision for generating omni-channel KPIs, attribution models and actionable insights to prove or disprove business / marketing hypotheses. Responsibilities include : Measurement of all omni-channel campaign performance, provide recommendations to optimize campaign ROI and inform the creation of more personalized and effective programs Develop overall marketing attribution models for measuring marketing's impact on business growth and sales funnel development Partner with marketers to develop business hypothesis and leverage predictive analytics and advanced statistical techniques to drive strategic...

The role of Technical Lead is an opportunity for a proven leader and technical expert in application delivery to help set and execute the design, engineering standards, and delivery processes, across Evernorth Accountable Care (ENAC) applications to achieve our growth and strategic goals. . Key Responsibilities: As a Pega/Workflow lead, you will identify the tasks and responsibilities on Pega Implementation, create and extend a Pega application, Manage rules and rulesets, leverage the Enterprise Class Structure (ECS) to promote rule reuse between case types and applications, configure roles, access groups, and privileges, manage data access within an application, create wizards to configure a sequence of assignments, design applications for multiple device types and screen sizes, including mobile devices and manage integration settings Create end-to-end Solutions that maximize alignment with target states and reuse of IT assets Work closely with cross-functional...

Remote, work from home - Dallas/Ft. Worth, TX (must live in/or near area)SummaryThe Provider Performance Advisor is a key member of a cross-functional, collaborative organization which includes Market Provider Performance, Sales, Stars & Risk Adjustment, Finance, Marketing, Provider Relations, and Network Development & Solutions. Reporting to the Provider Performance Senior Manager, the Provider Performance Advisor ensures the effective performance outcomes of their assigned providers.The Provider Performance Advisor's responsibilities include:* Cultivating key provider partner relationships in order to drive optimal performance on Stars, risk adjustment, utilization management, and overall financial performance.* Leading market level projects and strategies related to provider engagement.* Preparing for and facilitating external provider meetings and value based contract administrative meetings (JOCs).* Preparing for and facilitating a monthly financial review to senior...

DESCRIPTIONThe Clinical Program Advisor is part of an innovative team who have overall accountability for reimbursement policy creation, maintenance and project support. This individual will partner with many areas including prepay, business operations, and other matrix partners to assist with the implementation of reimbursement policies.DUTIES AND RESPONSIBILITIES* Proficiency with industry medical billing/coding and the ability to clearly explain coding logic including the use of modifiers is a must.* The ideal candidate will demonstrate a thorough knowledge of new code descriptions, the impact of code additions, changes or deletions to policies and associated code edits as well as the ability to review and understand data analysis.* This position is responsible for the identification of reimbursement policy opportunity, researching competitive landscape to stay current on trends, creation of a code edit strategy to align with reimbursement policies and will be the reimbursement...

Remote, Work from home, United States The Actuarial / Business Analytics Lead Analyst - Pharmacy Governance role will be a key contributor to the pricing governance team responsible for pharmacy governance initiatives, data and assumption process improvements, and methodology alignments, all of which are critical to support business decisions. This person will conduct actuarial studies, support technical updates, and communicate results, and will partner with Pharmacy Underwriting, Finance, and Economics. Responsibilities Analyze variances between underwriting projections and actual results, and investigate differences in collaboration with other teams including Pharmacy Underwriting, Economics, and Finance Conduct studies on pricing models and assumptions for accuracy, and monitor changes over time Examine methodology differences between tools, and support updates to existing models Provide actuarial support and analyses for strategic initiatives leveraging strong...

Remote, work from home - New Mexico (must live in/or near area) Summary The Provider Performance External Representative is a key member of the market that assists in the growth and development of the provider network. The External Representative is the primary conduit to the providers and the individual that represents Cigna MA. The Provider Performance External Representative's responsibilities include: Supporting the development, management and oversight of the physician/ provider network in his/her assigned (New Mexico, Albuquerque/surrounding northern counties) Establishing and managing strong, solid relationships with assigned provider groups and their staff (e.g. physicians, practice managers, care coordination teams), as well as executing with provider group on initiatives that benefit the customer, provider, and health plan. Educating providers on the performance requirements associated with value-based contracts. Conducting regular provider visits to...

This is a dynamic role in the Enterprise Data Office responsible for requirements gathering and analysis supporting lakehouse solution development. This role supports a wide variety of business analytics needs across eviCore stakeholders. It is a very customer focused role and communication is key as the resource will work directly with stakeholders to capture requirements across multiple teams. Healthcare background is a plus but not a requirement. Responsibilities: Gathers stakeholder needs in order to produce business and technical requirements. Updates release notes to keep stakeholders aware of new functionality. Performs quality assurance testing on development items to ensure accuracy of product. Analyzes existing or creates new SQL queries to perform analysis. Manages needs and requirements across our internal teams. Collaborates across teams and bridges gaps in understanding. Conducts analyses to identify business use cases, capability requirements, and...

Consumerism Account Specialist (Enrollment/Billing Senior Representative) SUMMARY: Provide client facing support to our current client book of business with focus on implementation and ongoing support for Cigna clients. RESPONSIBILITIES: Facilitate implementation of Consumerism banking processes for new and existing client base including:Facilitating client implementation meetingsCollaborating with client to make appropriate electionsTracking and reporting on all aspects of the client implementation and renewalsUnderstanding clients needs and abilitiesComplete vendor bank structure documents and internal structure requirementsPartner with service teamsEnsure best client/customer experience during implementationAttends client implementation and renewal meetings; provide support and information as needed ADMINISTRATION: Provide ongoing client support as needed including but not limited to:: Ongoing review of employee enrollment, clearing account management, funding, CIP...

This position is part of the IFP Coaching and Support team. The coaching & support care management programs help individuals make the behavioral changes and first steps necessary to initiate and engage in behavioral treatment. Our case managers are specially trained in coaching individuals with mental health and chemical dependency disorders. They have the entire suite of Evernorth services available allowing them to identify and service each individual's needs. The case manager offers Coaching & Support Care Management services that utilize a motivational interviewing approach focusing on decreasing both internal and external barriers that may be preventing the individual from initiating and/or engaging in behavioral treatment. This approach helps the individual move toward readiness to change and results in the creation of goals that will improve their health and well-being. Role Summary This position is a great opportunity for licensed behavioral health clinicians...

Summary The Clinical Research & New Solutions department develops, deploys and manages programs and capabilities rooted in health decision science. This department serves clients and patients through programs and services that support better drug, pharmacy and health choices. The department includes Knowledge Solutions, Consumer Solutions, Research & New Solutions and Clinical Services. In Knowledge Solutions, which this role resides within, provides best-in-class analytics to our customers by creating efficiencies via Self-Service tools, improving processes, and delivering new innovative Business Intelligence solutions to drive new sales, client retention and upsells. The Senior Analyst will provide support for advanced analytical and operational reporting, with focus on the database and infrastructure that supports end user applications. He/she will be expected to complete day-to-day project tasks without immediate supervision and will resolve non-routine issues...

SUMMARY The Director of Security Architecture is a senior leader in our Information Protection (CIP) organization reporting to the Managing Director of Security Architecture and Engineering. This Director will have a strategic partnership with Enterprise Architecture leaders and our Chief Information Security Officers. This leader will work hand in hand with Enterprise Architecture leaders in concert with his/her team to collaboratively define the security architecture for solutions across multiple domains and solution areas, contributing to the future success of an evolving business and healthcare industry. This collaboration will include areas such as cloud security (on-pre, public, hybrid, and multi-cloud), network security, endpoint security, application security, identity and access management, operational technology, internet of things technology, and more. RESPONSIBILITIES Lead development and maturity of the enterprise security architecture process to enable the...

The Senior Delivery Manager / IT PM Senior Advisor is a dedicated team member who has a primary responsibility to help the self-organizing, self-managing digital product team achieve its goals. Sr. Delivery Manager who focuses on making things happen, thus ensuring their teams have everything they need to succeed. They manage stakeholders and are responsible for coordinating across multiple departments to remove any impediments which could otherwise interfere with the teams focus and ability to deliver. The Sr. Delivery Manager is an individual contributor matrixed team leader who: * Creates & managers cross functional delivery plans * Helps them meet their daily and iteration objectives * Works to remove impediments, facilitates continuous improvement * Coordinates solution implementation and delivery with other teams Responsibilities: * Provides counsel and advice to top management on significant IT Project Management matters, often requiring coordination between...

How You'll Make a Difference: Database design and creation based on application specifications IMS Catalog support IBMHP utility experience Manage all aspects of an IMS database allocation: DASD DBDS/POOL, full function and HALDB space management, compression, encryption, DB utility creation and scheduling, performance/tuning, native IMS tools Migrate database through multiple levels of test/production IMS environments Creation and execution of ACB, PSB, DBD, MOD BLOCKS, DYNA, DBRC Manage backup, recovery, reorganization, tuning, replication, performance Interface with security and masking teams Identification of security requirements Work with application teams through our change management and problem resolution tool (Service Now) 24x7 pager support rotating with team member Weekend support for monthly application releases and DB Maintenance required. Develop and manage a disaster recovery plan for all production databases Work on complex projects with team sizes...

Summary The Digital Campaign & Marketing Analytics team is looking for an exceptional Marketing Insight Senior Advisor to lead the development and evolution of Cigna Medicare's Supplemental Benefits marketing analytics strategy and roadmap. The ideal candidate will partner closely with the marketing team, agency partners, senior management and other key stakeholders to develop a measurement framework for assessing the impact of marketing efforts as well as delivering actionable insights to optimize marketing performance. They will oversee the delivery of insightful data visualizations and employ advanced analytics, to drive meaningful impact for the business, through excellent communication skills and the ability to influence and drive change. Primary Responsibilities Lead the development of Cigna Medicare's Supplemental Benefits marketing analytics strategy and roadmap. Collaborate with marketing leaders to identify analytics challenges and develop solutions....