As a Client Account Support Lead Analyst on the PBM Operations (Client Service Delivery) Adjustments team, you will work directly with account teams and finance analysts to correct claims that processed incorrectly due to benefit setup issues, resulting in system-generated member and/or client refunds
ESSENTIAL FUNCTIONS:
- Partner with account teams to understand the scope/range of prescription claims that are potentially impacted by a setup error
- Using a repricing tool, submit claims to be re-adjudicated systematically against a corrected benefit setup
- Collaborate with account teams and finance analysts to review output from the reprice tool to determine if claims are now processing as intended
- Work with a finance analyst to uploaded “corrected” claims into the Information Warehouse
- Address complex adjustment scenarios with strategic mindset
QUALIFICATIONS:
- High School Diploma or GED required
- Understanding of the basic components of benefit design (e.g., copays, coinsurance, deductibles, etc.) preferred
- Strong analytical and communication skills, and an ability to collaborate with account teams and finance partners preferred
- Strong working knowledge of MS Excel preferred
- Bachelors’ degree preferred
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.
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: [email protected] for support. Do not email [email protected] 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.
Similar Jobs
What We Do
At Cigna, we're more than a health insurance company. We are your partner in total health and wellness. And we’re here for you 24/7 – caring for your body and mind.
As a global health service company, Cigna's mission is to improve the health, well-being, and peace of mind of those we serve by making health care simple, affordable, and predictable.
Our values are the core of our culture. Our values guide how all 74,000 of us around the world work together, serve our customers, patients, clients, communities, and deliver on our mission.
