Claim Operations Manager - Evernorth Accountable Care - Hybrid - The Cigna Group
Houston, TX
About the Job
Position Summary
Evernorth Accountable Care is a new business focused on partnering with healthcare providers to form value-based care relationships, improving care for patients and reducing total healthcare costs. Evernorth Accountable Care will be delegated select claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers. In support of the launch of the claims processing capabilities, Evernorth Accountable Care is seeking an experienced Claim Operations leader to build a high performing team of claim analysts and operations personnel to support the business in ongoing claim operations.
Essential Functions
The Manager of Claim Operations will oversee a team of 3-15 team members (combination of FTEs and contractors) that includes the following responsibilities:
+ Maintaining and managing relationships with nine claim clearinghouses
+ Serving as a primary liaison to one or more claim payment vendors
+ Developing and maintaining operational processes to investigate and resolve claim inquiries and issues reported by providers, payers, customer service, and internal stakeholders
+ Establishing operational processes in support of a close partnership with Evernorth Accountable Care Technology Production Support
+ Supporting claim adjustments processes, including interfacing with teams at payers to ensure claim adjustments opportunities are identified, prioritized, and processed in an efficient and accurate manner.
+ Supporting any manual intervention needed on claims, including late payment interest rules and calculations, liens and garnishment application, refund requests, and more.
+ Overseeing and managing a queue for reviewing and resolving claim fallout.
+ Partnering with Evernorth Accountable Care’s claim product management organization to inform requirements for technology enhancements that support the growth of the business.
+ Support business acceptance testing for new technology features that impact claim operations end users.
+ Establishing and maintaining processes that require collaboration with various enterprise groups, such as Provider Relations; Fraud, Waste, and Abuse; Accounting; Finance; and more.
+ Regularly communicating and presenting on the overall health of Evernorth Accountable Care claim operations to sr. leadership
+ Creating and maintaining standard operating procedures for the claim operations team
+ Providing onboarding and training to new team members
Qualifications
+ Bachelor’s Degree or equivalent work experience required
+ Previous healthcare claims experience required
+ 5+ years of experience in an operations setting required
+ 3+ years of leadership experience in an operations setting required
+ Proven ability to build, develop, and motivate high performing teams in a fast paced, high impact operations environment
+ Ability to delegate work in a manner that maximizes the strengths, skillsets, interests, and growth opportunities of the team
+ Experience establishing new operational processes and/or leading teams through a new initiative launch within a highly matrixed organization
+ Enthusiasm and passion to meet operational targets
+ Strong ability to navigate, communicate, and lead others through a high degree of change
+ Strong critical thinking skills and ability to navigate through ambiguity with limited oversight
+ Ability to predict challenges and seek to proactively head-off obstacles
+ High attention to detail and proven ability to manage multiple, competing priorities simultaneously
+ Experience preparing and delivering monthly operating review presentations to sr. leaders
+ Proven ability to develop strong working relationships and establish a high level of credibility across teams and lines of business
+ Periodic travel required
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 83,000 - 138,300 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._
Evernorth Accountable Care is a new business focused on partnering with healthcare providers to form value-based care relationships, improving care for patients and reducing total healthcare costs. Evernorth Accountable Care will be delegated select claims processing capabilities in certain geographic markets as part of its contractual relationships with payers and specialty network providers. In support of the launch of the claims processing capabilities, Evernorth Accountable Care is seeking an experienced Claim Operations leader to build a high performing team of claim analysts and operations personnel to support the business in ongoing claim operations.
Essential Functions
The Manager of Claim Operations will oversee a team of 3-15 team members (combination of FTEs and contractors) that includes the following responsibilities:
+ Maintaining and managing relationships with nine claim clearinghouses
+ Serving as a primary liaison to one or more claim payment vendors
+ Developing and maintaining operational processes to investigate and resolve claim inquiries and issues reported by providers, payers, customer service, and internal stakeholders
+ Establishing operational processes in support of a close partnership with Evernorth Accountable Care Technology Production Support
+ Supporting claim adjustments processes, including interfacing with teams at payers to ensure claim adjustments opportunities are identified, prioritized, and processed in an efficient and accurate manner.
+ Supporting any manual intervention needed on claims, including late payment interest rules and calculations, liens and garnishment application, refund requests, and more.
+ Overseeing and managing a queue for reviewing and resolving claim fallout.
+ Partnering with Evernorth Accountable Care’s claim product management organization to inform requirements for technology enhancements that support the growth of the business.
+ Support business acceptance testing for new technology features that impact claim operations end users.
+ Establishing and maintaining processes that require collaboration with various enterprise groups, such as Provider Relations; Fraud, Waste, and Abuse; Accounting; Finance; and more.
+ Regularly communicating and presenting on the overall health of Evernorth Accountable Care claim operations to sr. leadership
+ Creating and maintaining standard operating procedures for the claim operations team
+ Providing onboarding and training to new team members
Qualifications
+ Bachelor’s Degree or equivalent work experience required
+ Previous healthcare claims experience required
+ 5+ years of experience in an operations setting required
+ 3+ years of leadership experience in an operations setting required
+ Proven ability to build, develop, and motivate high performing teams in a fast paced, high impact operations environment
+ Ability to delegate work in a manner that maximizes the strengths, skillsets, interests, and growth opportunities of the team
+ Experience establishing new operational processes and/or leading teams through a new initiative launch within a highly matrixed organization
+ Enthusiasm and passion to meet operational targets
+ Strong ability to navigate, communicate, and lead others through a high degree of change
+ Strong critical thinking skills and ability to navigate through ambiguity with limited oversight
+ Ability to predict challenges and seek to proactively head-off obstacles
+ High attention to detail and proven ability to manage multiple, competing priorities simultaneously
+ Experience preparing and delivering monthly operating review presentations to sr. leaders
+ Proven ability to develop strong working relationships and establish a high level of credibility across teams and lines of business
+ Periodic travel required
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 83,000 - 138,300 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._
Source : The Cigna Group