Business Project Analyst Claims Systems - EviCore - Remote

The Business Project Analystis a key role working closely with the claims systems and configuration team, project management, and stakeholder SME’s to develop, improve, monitor, and maintain EviCore Claims Systems. The work will be a mix of project and production support including program configuration, compliance, performance management, root cause analysis, data stewardship, business requirements definition, testing support and validation. This role will report to the Business Solutions Manager focusing primarily on process improvements and strategic initiatives within the Claims Systems Space. Work can range in content including (but not limited to) Root cause analysis of systemic issues that impact claims processing, performance management, or process improvement. A fundamental understanding of claims processing, configuration, and adjudication is required for success in this role. Job Components and Deliverables PROGRAM MANAGEMENT:

• Production Support– Monitor controls and Identify issues; root cause analysis, solutioning, document and maintain log of issues
• Project Support –Develop and manage detailed business requirements using a combination of stakeholder input and subject matter expertise, document validation requirements (including use case definition, expected results, defect logging, validation and governance of process)

DRIVING SOLUTIONS:

• Root Cause Analysis –analyze data, system workflows, requirements and feeds to determine issue cause and appropriate solutioning suggestions
• Facilitation– lead and document idea sessions around problem resolution to address business needs
• Process – follow portfolio and production processes to resolve issues and identify project needs. Including but not limited to Intake creation, project request forms and collaterals, business case support, status reporting updates, communications surrounding issues and fixes, and governance support (logs, materials, decision support)

COMMUNICATION:

• Sponsorship / Senior Level– Concise, effective communication around progress, risks, timing and decisions needed at the senior level
• Team– Detailed plans and activities to identify timing and ownership.
• Organizational – Clear, effective communication to matrix partners on timing / impact of implementations on their departments.

Cigna Core Competencies ALIGN:

• Manages Complexity– Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems
• Manages Conflict - Handling conflict situations effectively, with a minimum of noise – applying knowledge of business and the marketplace to advance the organization’s goals
• Collaborates– Building partnerships and working collaboratively with others to meet shared objectives.

INSPIRE:

• Communicates Effectively– developing and delivering multi-modal communications that deliver a clear understanding of the unique needs to different audiences
• Persuades– Use compelling arguments to gain the support and commitment of others

DEVELOP:

• Nimble Learning– Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.
• Situational Adaptability– Adapting approach and demeanor in real time to match the shifting demands of different situations
• Tech Savvy– Anticipating and adoptinginnovationsinbusiness-buildingdigitalandtechnologyapplications.

DELIVER:

• Drives Results– holding self accountable to meet commitments
• Action-Oriented– consistently achieving results, even under tough circumstances
• Optimizes Work Processes– Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement.

BASIC QUALIFICATIONS:

• High School Diploma or GED required
• 3+ years of experience with claims adjudication engines (CAE) required (ex: Facets, QNXT, HRP)
• Experience with documenting business requirements for configurations and adjudication rules
• 3+ years of Business Analysis, Agile product support, Project Management, or applicable experience, required
• Agile / Traditional requirements development / delivery methodology awareness
• Demonstrated experience and mastery in skills listed above
• Working knowledge of EviCore operations, systems, and client data

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. Apply tot his job Apply To this Job