Job description

We are seeking a detail-oriented organized Risk Adjustment Analyst to join the Individual and Family Plans (IFP) Operations Team . Reporting to the IFP Operations Claim Payment Integrity Senior Manager, the person in this role will be responsible for working with partners in IFP and across the Cigna enterprise to ensure accurate and timely resolution of pended or denied claims to maximize Risk Adjustment reimbursement opportunities each year. Strong communication skills and effective time management skills are critical to the success of this role; knowledge of IFP Medical, IFP Dental and IFP Pharmacy are strongly preferred.
Key Responsibilities
Assist the organization as a subject-matter-expert in Affordable Care Act (ACA) Risk Adjustment claims by managing inventory which includes pended and denied claims
Manage research initiatives to monitor claim performance over time and recommend future enhancements
Provide training and guidance to other teams on the Risk Adjustment claims management/oversight processes
Attend internal team meetings and calls to ensure alignment around Risk Adjustment program objectives, deliverables, and timelines.
Assist in the definition of project scope and objectives, involving all relevant stakeholders and ensuring technical feasibility
Ensure resource availability and allocation of Risk Adjustment Projects/initiatives
Determine and articulate a clear vision of the project/programs/processes and motivate the supporting teams to achieve objectives
Ability to work independently as well as contribute to knowledge-sharing within a team environment
Track project performance, specifically to analyze the successful completion of short and long-term goals
Establish Policies and Procedures and/or supporting standard operating procedure documents as needed
Follow-up and follow through with any and all request/action items with business partners
Escalate needs as necessary to manager
Make outreach to providers as applicable to request necessary information to finalize claim
Additional duties as assigned

Required Qualifications
High School Diploma or GED required with experience; Bachelor's degree preferred
1+ year of health insurance claims work experience; strong preference for experience with IFP medical/dental/pharmacy
Ability to demonstrate strong proficiency using MS Suite and other systems
Ability to build, foster, and maintain positive professional relationships
Keen analytical and research abilities
Problem-solving and conflict resolution capabilities
Willingness to develop an in-depth understanding of the business and related services
Strong communication skills

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 22 - 33 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 Group .

About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.

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