Cigna is an American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance, and related products and services, the majority of which are offered through employers and other groups. Cigna is incorporated in Connecticut.
Jobs at Cigna
Customer Service Advocate- Cigna- Work at home! 6 locations
Customer Advocates help our 90+ million customers make the most out of their Cigna benefits. Here’s a little more about what you’ll do:
Help clients, customers, and health care providers understand our business a little better. Topics like determination of payments and claims related to medical and dental procedures and office and hospital visit costs are common questions.
Make it easy for customers to work with us. Take ownership of their issues and do your best to resolve them over the phone the first time, every time.
Be an advocate for health and wellness. Educate customers on disease management programs and make recommendations on the right healthy living programs for their needs.
Essential Functions
Provide direction and leadership in strategic planning as it pertains to powering the end to end technology stack for Evernorth businesses
Lead and manage a team of business product owners (BPOs) and/or business and technology advisors
Understand, gather, review, analyze, validate, evaluate, and story map business processes/systems and user requirements in coordination with the business, technology, and software engineering
Translate product roadmap features into well-defined product requirements including, but not limited to, business value and expected outcomes/acceptance criteria.
Continuously engage with the business, technology, and other key stakeholders to stay informed, nurturing strong and trusting relationships and increasing business knowledge to represent product vision, strategy, and customer/business needs
Create, own, and manage the team backlog, constantly collaborating with customers and the team to ensure work items are refined and prioritized
Provide context for prioritizing and accepting the work demoed by the agile team, specifically ensuring the right value is delivered
Help identify organizational impediments and work with the leadership team to create effective strategies to overcome them.
Exemplify agile principles, encourage good practices, and assist the team to continue to develop and mature in agile practices and methodologies
Work in an agile environment and continuously reviews the business needs, defines priorities, outlines milestones and deliverables, and identifies opportunities and risks.
Provide counsel and advice to top management/stakeholders on significant matters, often requiring coordination between different teams and organizations.
Proactively resolve upstream dependencies and resolve conflict effectively across teams.
Effectively communicate the products team’s goals and accomplishments to peers and leadership showing the value the product is bringing to the business
Foster the adoption of product enhancements to end-users and track and report on value creation
Qualifications
Bachelor’s degree in business, computer science, engineering, or related field; master degree a plus but not required
15+ years’ work experience as a product owner, business analyst, or in a related field
Excellent technical abilities, effective analytical abilities, verbal and written communication skills
Understanding and experience managing system/IT lifecycle, implementation, change management, and support
Strong working knowledge and experience (or a keen interest in) with Request for Proposal (RFP), contract lifecycle management, CRM, and sales enablement tools. Examples, RFPIO, Apttus, Salesforce, Highspot, Marketo, etc.
Experience with discerning business requirements and mapping them to both business processes and tool
Experience working in technology or in close engagement with technology
Accurate and precise attention to detail
Able to build strong interpersonal relationships with business analysts, technology/engineering teams, leadership, senior management, and internal and external stakeholders
Proficient computer skills, including experience with Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel); working knowledge of software development
Comfortable working with multiple teams, in-house and remote
The high degree of comfort working in a fast past environment and be able to manage multiple initiatives/projects simultaneously
Strong project management skills and experience
Ability to gain a fundamental understanding of new methodologies, technologies, and the health service industry
For this position in Colorado, we anticipate offering an annual salary of 132,400.00, +/- 20%, depending on experience.
This role is also anticipated to be eligible to participate in an annual bonus and long-term incentive plan.
Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class 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 dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the “Life at Cigna” tab on our career site:
South Carolina Berkeley, Missouri, Franklin, Tennessee, Melbourne, Florida, Plainville, Connecticut, West Seneca, New York
Primary Functions
Manages multiple implementations with cross-functional teams.
Develops project task plan with all key milestones required to achieve business objectives.
Self-sufficiently develop project approach (key stakeholders, need for sub-teams, phases, operating mechanisms, etc.).
Objectively plan and execute project kickoff to launch the project.
Develops a risk management plan
Supports projects that define and implement major process improvements across a department or multiple business functions.
Supports process improvement events through facilitation
Key Qualifications
Bachelor’s degree preferred; Master’s degree preferred
10 years relevant project/program management experience with technical implementation work preferred
Healthcare experience required, Health Plan/Carrier/Payers, preferred
Strong analytical, planning, problem identification, and resolution skills required
Demonstrated self-initiative
Excellent communication skills with internal and external partners in various functional areas and at all levels of management.
Understanding of continuous improvement principles to grasp and communicate “the why” in the process to achieve results.
Solid leadership skills, demonstrated ability to lead, oversee and motivate cross-functional teams in a complex corporate environment.
Demonstrated ability to deliver against aggressive goals
Understanding of the healthcare industry and utilization management a plus
Proven ability to plan for and integrate multiple tasks concurrently as well as work independently
Ability to identify and engage cross-functional teams in support of project completion, while obtaining buy-in from stakeholders
Responsibilities:
End-to-end management of multiple cross-functional and focused risk adjustment coding initiatives that vary widely in scope and often have overlapping timelines.
Leads a diverse team of 25-30 professionals, consisting of Managers, Advisors, and operational support personnel to ensure that risk adjustment coding initiatives are completed in a compliant fashion and within mandated timelines. The team is expected to grow as the complexity and frequency of audits increase. Responsible for hiring, counseling, and developing manager and advisor team members, as needed, to ensure that Cigna's pipeline of talent is broadened.
Directs, develops, implements, and monitors Cigna's Medicare RADV coding projects, which include both CMS and other regulatory agency initiated audits, as well as those initiated at the direction of the compliance and legal teams.
Develops and maintains work plans that consider the priorities, key milestones, time and cost estimates, resource requirements, task sequencing, and identification of tasks that may be performed concurrently to achieve objectives.
Provides leadership and partners with Stars and Risk Adjustment Analytics team to lead the evaluation of business processes and technologies, creating process maps, and trending analyses to resolve business issues.
Collaborates with Stars and Risk Adjustment Analytics team to define reporting needs based upon customer-driven requirements from government agencies, internal leadership teams, and coding operations.
Monitors and evaluates key performance indicators and works collaboratively with leadership to report on influencing factors and evaluating trends on internal coder and external coding vendor performance and optimization progress
Analyzes and measures the effectiveness of existing Risk Adjustment coding initiatives and collaborates with matrix partners to lead and develop a sustainable, repeatable, and quantifiable process for growth.
Oversees any vendor-based chart retrieval initiatives related to internal and external audits to ensure that day-to-day solutions are performed as designed
Partners with the broader Risk Adjustment team to incorporate audit findings into existing Risk Adjustment coding processes, and proposes enhancements and/or modifications as needed to effect better future outcomes.
Leads efforts of Quality Review Audit Advisor (leader of the Coding QA Team) to ensure Risk Adjustment coding activities performed by the internal and vendor Risk Adjustment coders adhere to Cigna’s Coding Best Practices and CMS regulations.
Provides ongoing and timely updates on Risk Adjustment coding activities to senior leadership and key stakeholders.
Works closely with the Risk Adjustment leadership team to establish metrics for critical coding activities and provide updates to segment leadership on a regular basis.
Ensures that risk adjustment coding audit projects are completed within the established timeframes and are integrated with other business and related projects.
Qualifications Include:
Bachelor’s degree in business or related field preferred. HS Diploma required.
At least 5-7 years of experience in Medicare Risk Adjustment required, preferably with Risk Adjustment coding QA
Experience working in Risk Adjustment coding operations preferred
Experience evaluating or writing coding guidelines
Knowledge of CMS RADV audits and approaches
At least 3-5 years management experience, preferably in healthcare
Strong organizational skills
Ability to present sensitive and complex information to executives
Demonstrates ability to deal with ambiguity and to turn plans into actions
Demonstrates the ability to take initiative and act with urgency and integrity.
Demonstrates strong leadership skills in order to motivate, mentor, and inspire team members.
Exceptional communication skills, including written and verbal (formal and informal)
Demonstrated change agent skills within a matrix environment
Demonstrates strong proficiency in Microsoft Office skills related to Excel, Visio, PowerPoint, and Word.
This position is not eligible to be performed in Colorado.
Our Patient Care Advocates have dedicated team members who excel at customer service, helping us elevate our patient care to new heights. In this crucial role, you are on the front lines with patients, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.
Here’s a little more on how you’ll make a difference:
Help patients understand their pharmacy benefits better. Use the knowledge you gain from training, your problem-solving skills, and support from your team to answer patient calls effectively.
Help us keep track of our patient interactions. While on calls, use your expert listening skills to get to the heart of a patient’s question quickly and document all interactions in real-time.
Ensure patients are equipped with the best advice. Identify and empathetically address patient concerns and, if necessary, escalate appropriately.
What You Should Have:
High School Diploma / GED required
1 year of relevant experience
General PC knowledge including Microsoft Office
Excellent communication skills (verbal and written)
What you’ll love about working here:
Fun, friendly, and unique culture – Bring your whole self to work every day!
Choice of three unique medical plans
Prescription Drug, Dental, Vision and Life Insurance
Employee Contributions for HRA and HSA accounts
401K with Company Match
Paid Time Off and Paid Holidays
Tuition Assistance
Enrollment/Billing Representative – Accredo Memphis, Tennessee
Delivers straightforward administrative and/or other basic business services in Enrollment/Billing. Provides financial-related support for banking and/or billing-related functions to new and/or existing accounts. Sets up, manages, reconciles, processes, and/or balances bank and/or customer accounts. Works with internal/external customers, banks, vendors, and/or partners to resolve issues. May create, analyze and respond to standard and/or non-standard reports. Bills and/or collects outstanding/delinquent payments or issues payments. Audits account for compliance. Supports mid to large markets. Issues tend to be routine in nature. Good knowledge and understanding of Enrollment/Billing and business/operating processes and procedures. Works to clearly defined procedures under close supervision.
ESSENTIAL FUNCTIONS
Prepares and reviews claims to ensure billing accuracy.
Pursues collection activities to obtain reimbursement from payers and/or patients.
Frequent follow-up with payers and/or patients on outstanding accounts.
Escalates delinquent and/or complex claims to Sr. Billing & Reimbursement Specialists for appropriate action.
QUALIFICATIONS
High School Diploma or GED required.
2-3 years relevant experience.
PC Skills including Microsoft Outlook, Excel, Word, and Internet.
Detail-oriented and strong organizational skills.
Self-starter and team player.
Focus on quality and service.
Demonstrated ability to meet multiple deadlines and manage a heavy workload.
Integrity to handle sensitive or confidential information is critical.
ABOUT THE DEPARTMENT
Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis, and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients’ lives.
NOTE: We are currently training in a work at home environment, and you will be required to have reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable and you may need to purchase an Ethernet cord depending on your current setup.
***Virtual - Must live within 100 miles of Orlando FL***
Delivers straightforward administrative and/or other basic business services in Eligibility. Implements and maintains eligibility for benefits. Implements, updates, and maintains automated, direct connect, and/or manual eligibility data. Interacts with internal partners and/or external clients/vendors. Generates reports to identify and resolve discrepancies. Identifies process improvement opportunities for own cases. May negotiate and resolve eligibility with clients. May provide technical support for the electronic processing of eligibility. Ensures customer data is installed accurately and timely. May work with client's format and internal Systems to resolve errors. May interact with Systems to resolve technical issues. General knowledge of manual and automated eligibility. Familiar with reporting tools. Technical understanding of systems. Issues tend to be routine in nature. Good knowledge and understanding of Eligibility and business/operating processes and procedures. Works to clearly defined procedures under close supervision.
Have you heard? Express Scripts and Accredo are now part of Cigna. Together, we’ve got big plans. How big, you ask? We want to change health care to make it more affordable, more personalized, and more focused on helping the whole person to achieve better health outcomes. And that’s only the beginning. Read on to learn more about working with us.
As an Eligibility Representative, you will be part of a team passionate about helping our patients with billing and ensuring their access to life-saving medications.
What you’ll do:
Facilitates cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time
Independently resolve basic patient claims issues using key subject matter knowledge
Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations
Effectively collaborate with internal departments to resolve issues or provide any needed information
Contact benefit providers to gather policy benefits/limitations
Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
Perform medical/pharmacy benefits verification requiring complex decision skills based on payer and process knowledge
What you’ll need:
High school diploma or GED
3-5 years of relevant working experience
Experience with health care, medical insurance terminology, and patient access preferred
Strong data entry skills and computer skills
Excellent phone presentation and communication skills
Demonstrated ability to handle difficult conversations in a professional manner
Ability to adapt in a dynamic work environment and make decisions independently
Advanced problem-solving skills and the ability to work collaboratively with other departments
NOTE: We are currently training in a work at home environment, and you will be required to have reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable and you may need to purchase an Ethernet cord depending on your current setup.
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