Plan Implementation Sr. Representative - Evernorth - Remote
The job profile for this position is Plan Implementation Senior Representative, which is a Band 2 Professional 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.
Summary
Manages provider demographic and reimbursement data for Client Specific Networks. Reports to client contacts and collaborates with internal teams to ensure accurate provider systems for claims and directories. Supports Provider Loading projects as needed.
Responsibilities
- Load and configure system applications for managed care contracts.
- Maintain and update client-specific network data.
- Manage network maintenance tasks.
- Interpret and apply CSN contracts using appropriate tools.
- Partner with Business Intelligence to automate networks and resolve claim issues.
- Perform root cause analysis and resolve issues using internal resources.
- Ensure provider data accuracy and network quality.
- Investigate and resolve claim issues.
- Audit data for system alignment and integrity.
- Lead process improvements and automation initiatives.
- Communicate demographic and reimbursement setups to matrix partners.
- Identify workflow improvements and volume reduction opportunities.
Qualifications
- High school diploma or GED required.
- 1+ years of experience working with managed care data systems and claims applications (Ex. Proclaim and/or HCPM) highly preferred.
- Experience with account management/handling a book of business is highly preferred.
- Strong technical, analytical, and decision-making skills.
- Proficient in Microsoft Office (Excel experience using pivot tables and VLOOKUPs is highly preferred)
- Able to manage multiple tasks independently.
- Accurate data management and strong communication skills.
Competencies
- End-to-end process knowledge
- Critical thinking
- Prioritization
- Organization
- Responsiveness
- Clear communication
- Customer focus
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 hourly rate of 24 - 37 USD / hourly, 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. 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