Job Description

Delivers specific delegated tasks assigned by a supervisor within the Network Management job family. Prepares, analyzes, reviews, and projects the financial impact of facility, ancillary, group, and/or behavioral health contracts. Drafts contracts and conducts pre-contractual audits and surveys. Demonstrates knowledge of contracting processes, contract management, network operations, Medicare fee schedules, financial terms, and performance metrics.

Completes day-to-day Network Operations tasks with minimal supervision, while maintaining ready access to guidance from more experienced team members. Responsibilities require forward planning and anticipation of needs or issues. Resolves non-routine issues escalated by more junior team members.

POSITION SUMMARY

The Senior Analyst, Provider Claims Support is responsible for supporting both Network Providers and Internal Business Partners across all aspects of provider-submitted claims. This role assists with claim-related issues identified or reported internally and externally.

The position supports the execution of operational activities within the Retail Network in alignment with ESI's work plan and in compliance with requirements for Express Scripts clients and applicable regulatory agencies, while also supporting the operational needs of Network Providers. Additionally, this role supports the facilitation and execution of strategic network initiatives, requiring cross-functional coordination to lead, own, and manage relationships with Network Providers, internal Supply Chain business partners, and client account teams.

ESSENTIAL FUNCTIONS

• Provides daily operational support for claim issues arising from provider inquiries, as well as internally and externally identified claims issues.

• Performs operational support activities including claim investigation, reject validation, and escalated issue management.

• Collaborates with cross-functional internal and external teams to provide ongoing support of Sponsors and their requirements.

• Serves as a subject matter expert in claims analytics and technical support. Acts as a primary point of contact for internal partners (e.g., Sales and Account Management, Network Implementation, Provider Compliance) regarding claim-related issues, managing ad hoc inquiries and facilitating provider outreach.

QUALIFICATIONS

• Bachelor's degree in a related field, or equivalent relevant work experience (preferred).

• Knowledge of the healthcare and/or PBM industry.

• Strong problem-solving and analytical skills.

• Ability to work cross-functionally to research and resolve complex client and provider issues on a regular basis.

• Ability to manage multiple escalated issues simultaneously under tight timelines.

• Ability to adapt in a dynamic work environment, learn quickly, solve problems, and make decisions with minimal supervision.

• Basic proficiency in Microsoft Office applications, including PowerPoint, email, and spreadsheet software.

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 62,200 - 103,600 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.

At The Cigna Group, 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), 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, click here ( .

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Job Tags

Similar Jobs