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Claims Manager

Created07/22/2021
Reference21013308
CategoryCustomer Service & Claims
Job typeFull Time
CountryUnited States
Zip15689
SalaryCompetitive
** Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.

Responsibilities
  • Manages claim organizational metrics for days mail on hand, performance guarantees and staffing.
  • Manages the daily operations of claim organization 100+ FTE; Effectively communicates organizational strategies to engage staff and drive desired behaviors
  • Exhibits managerial courage and consistently delivers accurate and transparent messages to staff
  • Responsible for interfacing with senior leaders, direct reports and team to be within compliance of our Management Operating System.
  • Responsibility for strategic analysis of MOS data to gain deep insights in order to proactively recommend improvements related to MOS tools, team results and processes to drive operational efficiencies and improvements across aligned organization.
  • Demonstrates strong individual competency as well as coaches/ mentors others on all Management Operating System (MOS) tools to include Barrier Time Tracker, Daily Schedule Controls, Automated Scorecard, Performance Profile and Quartiling.
  • Address MOS findings at the team, cross team and organizational levels, working to remove barriers for individuals and beyond as a change leader to staff and matrix partners with regard to efficiency and quality.
  • Partners with Resource Management, Short and Long term Capacity Planners to deliver on operational and client expectations
  • Builds and support a high performance culture within Medical Claim, focusing on employee training and development, regular and open communication, individual/team accountability and recognition.
  • Lead/participate in projects and initiatives in support of service and operational excellence and providing consistent, positive impact to teams.
  • Work with partners to ensure claim performance meets or exceeds both quality and time to process goals.
  • Drive efficiencies with Late Payment Interest and financial planning.
  • Utilizes active management processes to develop direct reports, enabling the team to successfully balance accuracy and quality with productivity to drive positive results with a goal of 100% accuracy.
  • Meets business financial objectives through effective implementation of expense targets while meeting and exceeding customers' expectations and commitments
  • Adapts communication style to effectively engage individuals/teams in a virtual environment, delivering communications positively and in support of organizational goals and objectives
  • Drive mid to large scale operational improvement opportunities that impact quality, accuracy, and efficiency, modeling change leadership and influencing individuals at all levels to take appropriate risks
  • Collaborates with internal and external matrix partners to ensure objectives and standards are met, policies and procedures are followed, gaps identified and closed, communications are clear
  • Strengthen and drive linkages within Service Operations functional areas as well as with key matrix partners including Sales, Total Health and Network, Product, Underwriting, IT and Finance
  • Responsible for partnering with HR on people initiatives including compensation planning, performance management, staffing and employee relations concerns/issues, employee recruitment, training, teaming and employee development.
  • Facilitates compliance with all corporate policies for the claims processing staff.
  • Supports diversity by building an inclusive environment and valuing different perspectives
  • Ability to prioritize critical objectives focusing on high impact components
  • Ability to work with high sense of urgency
  • Demonstrates ability to effectively communicate verbally and in writing, both with senior leaders in the organization and in disseminating information to staff
  • Demonstrate mastery of Proclaim Claim Management, and the functional and technical knowledge and skills to manage the business.
  • Ability to mentor and coach supervisors to meet or exceed goals successfully.


Qualifications:
  • 2+ years' experience with Claim Payment Organization - influencing automation, quality, performance guarantees & Management Operating Systems (MOS) tools and methodologies required.
  • 2+ Experience with Global Service Partners; expansion of relationships, calibration of performance and Service Level Agreements required.
  • Experience leading automation and system enhancement calls within the Proclaim Claim Payment Application.
  • Experience with Account and Client meetings and non-standard claim payment request.
  • Proven track record of effectively driving change through strong partnerships and engagement with Global Service Partners, management and front line teams.
  • Partnership with Operating Effectiveness teams on solutions.
  • Experience leading capacity planning and staffing needs in addition to, training needs and inventory.
  • Excellent communication, interpersonal and negotiation skills required
  • Ability to problem solve, manage priorities and meet deadline with urgency.
  • Prior experience managing direct reports and leading project teams
  • Demonstrated experience in seeking out, building and nurturing strong relationships with partners.
  • Demonstrates managerial courage and change leadership in a dynamic environment
  • Responsible for driving change and influencing individuals at all levels of the organization.
  • Demonstrates skill in influencing others and relating to individuals at all levels of the organization required.
  • Experience working in a blended office, work at home and/or virtual work environment preferred.


This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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.
Employer091 Cigna Health & Life Ins. Co.

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