Employment Spot

Job Description

Manages the accurate and timely adjudication of claims and administers disposition according to contractual benefits and company procedures. Provides direction and guidance regarding policies, procedures, workflows, claim service quality, and training needs. Responsible for monitoring claim service standards. Typically has B.A. degree and eight or more years of experience in benefits and claims administration with three or more years of management experience. May serve as a single point of contact for customer base to manage account, trend issues and develop action plans for improvement. Regularly meets with customers to discuss results and issues. Communicates and educates regarding issues/trends to minimize errors. May conduct client presentations to review site operations and answer service questions regarding hiring and training of staff, roles and responsibilities of functional areas etc. May assist in presale and case implementation activities. Monitors Performance Guarantees to minimize financial impacts..Partner with contracting to pro-actively make recommendations on changes to improve service levels based upon root cause analysis. Development and management of action plan with solutions to address root causes.
Facilitation of meetings to ensure understanding of contract administration: ensure no interpretation issues exist.
Accountable for monitoring and driving all service related results for provider, ensuring all metrics meet or exceed provider expectations.
Work to transition provider back to utilizing normal service channels.
Participate in/lead special project initiatives.
Other duties as assigned..

Job Requirements

Advanced knowledge of PMHS and Proclaim claims systems required; knowledge of Intracorp Case Management System (ICMS), Central Provider File (CPF), Provider Workbench, Excel and Access helpful. Experience working with Service Operations Research and Reconciliation (R&R) HIGHLY PREFERRED - please highlight your experience with R&R on your resume.
Demonstrated ability to successfully interact with both internal and external customers at all levels.
Demonstrated ability to perform root cause analyses on claims issues.
Demonstrated ability to manage and resolve problems to satisfactory completion.
Project management skills to include time management, task analysis and breakdown and resource utilization.
Strong facilitation and negotiation skills - demonstrated ability to present detailed technical information to a less knowledgeable audience and negotiate resolutions in a mutually beneficial manner to both CIGNA and the customer.
Demonstrated ability to manage and lead without direct authority.
Demonstrated ability to see the "big picture" - understand how each phase of the claims payment process affects the end result and customer satisfaction.
Demonstrated ability to handle confrontational situations in a professional manner ending in a better partnership between CIGNA and the customer.
Demonstrated ability to take ownership of tasks/projects and perform work under minimal supervision with exceptional outcomes.
Experience with provider contracting or loading helpful..

CIGNA offers a competitive compensation and comprehensive benefits package including health and wellness benefits, 401k plan, and work/life balance programs, as well as opportunities for career growth and development.

At CIGNA, we are committed to providing our customers with employee benefits, expertise and services that improve the health, well-being and productivity of their employees. CIGNA's people are the key to our success in a changing and increasingly competitive marketplace. The collective skills, behaviors and work experiences of all CIGNA employees enable us to make a real difference in the lives of our members. We seek the most talented and creative minds in the industry to develop innovative solutions our customers value and consumers expect.