Manager Claims Systems - EviCore - Remote

The job profile for this position is Operations Manager, which is a Band 4 Management Career Track Role. 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. The Manager of Claims Systems will own process design, tactical implementation and execution of strategies within the Claim Systems and Configuration teams through delegation or personal execution. The position oversees the day-to-day operations with ultimate responsibility for the successful completion and quality of claims systems deliverables. This position will perform duties under self-direction, have decision making responsibilities and act under the supervision of and assist the Sr Manager of Claims Systems, as needed. Primary duties include, but are not limited to:

• Oversight of Claims Systems initiatives change control, risk assessment/management, impediment removal, as well as progress reporting to the Director of Claims Systems and/or other leadership, as required.
• Collaborate with the Claims Business Process Solutions, Claims Business Intake Team and Claims Product and Planning team for claims backlog governance workflow input, process improvement initiatives and resource impediments solutions.
• Provide input, as needed, toward LBC and OC discussions with Claims Leadership and Product and Planning resources.
• Through personal execution or delegation, ensure creation/maintenance of departmental work instructions, policies and workflows required to ensure success of deliverables and transition of knowledge to team members and other internal departments.
• Provide final approval of department work instructions, policies, workflows and training, as well as ensure audits are performed to verify adherence is met appropriately and timely.
• Motivate and guide the department to meet and exceed all goals and objectives as set forth by leadership.
• Support team Supervisors and Trainers regarding knowledge growth (i.e. platform, program, process, etc.).
• Support team Supervisors in personnel activities (i.e., time and attendance, recruitment, annual performance evaluations, payroll, disciplinary procedures, training, etc.).
• Oversight of departmental audit control maintenance, adherence to audit controls and audit control artifacts are accessible upon request through collaboration with the Compliance team.
• Provide support to Claim Systems resources to overcome knowledge impediments or client escalations, which the Trainer and Supervisors are unable to overcome, through appropriate channels of support available both internally and externally.

Minimum Education, Licensure and Professional Certification requirement: High School Diploma required, Bachelor’s degree preferred. Minimum Experience Required:

• 5+ years of healthcare claims life cycle and client/vendor relationship experience, with an emphasis in healthcare claims system configuration/implementations.
• 2+ years of supervisor experience

Skills:

• Proficient in Excel, Word and Access, required.
• Knowledge of SQL data query.
• Experience in claims adjudication platform, maintenance and implementation required.
• Experience in Business Quality Assurance processes, required.
• Commitment to expand knowledge of claims, adjudication platform and supportive systems in accordance with initiative/request needs.
• Knowledge of Agile and Kanban, required.
• Knowledge of Jira board and dashboard management, a plus.
• Strong analytical and critical thinking skills, required.
• Strong decision-making skills, required.
• Strong aptitude for process improvement, required
• Strong communication skills, required
• Ability to supervise, multitask and work independently in a fast-paced environment are essential skills for this position

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 87,100 - 145,100 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. 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. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. Apply tot his job Apply To this Job