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Payer Relationship Advisor

Created09/15/2021
Reference21017063
CategorySales & Business Development
Job typeFull Time
CountryUnited States
Zip15689
SalaryCompetitive
The Payer Relationship Advisor (PRA) is part of the account management team and is responsible for being a liaison between the Shared Administration Payers and Cigna. The PRA is responsible for ensuring payer compliance with the agreed upon standards via submission of scorecards, processed claim files and by conducting periodic audits. The PRA is also responsible for raising and supporting global service improvements and initiatives as a shared administration subject matter expert. This shared administration knowledge is also used to support the Cigna New Business Managers throughout the sales process and the Client Managers with ongoing service. The PRA also works on various escalated issues and projects as requested by the segment management.

Responsibilities:
  • Work to create and maintain quality partnerships with assigned SAR payers that propels SAR membership growth through new case sales, facilitates references and high SAR persistency, including:
    • Strong partnership with NBM and CM staff
    • Payer partnership satisfaction with Cigna as voiced
  • Provide support to segment NBM's and CM's to achieve earnings, growth, and persistency metrics.
  • Partner with Network to track payer concerns/issues relative to provider contract requirements and drive change to provider contract language.
  • Partner with Network to track provider concerns and improve payer education and compliance with Cigna provider contract requirements.
  • Ensure Payer compliance with Cigna standards or accepted alternative.
    • Payers compliance with Scorecard submission
    • Payer audits in accordance with Plan
    • Payers compliance with providing paid claim data
  • Be an engaged, integral, effective member of the SAR Account Management and Service teams
  • Provide regular reports to Account Management and Service teams, progress on changes to facilitate sales process.
  • Provide regular reports to manager and sales team on Payer specific and global issues, fixes, product enhancements, product challenges.
  • Ensuring payer compliance relative to Scorecard reporting - working with payer to determine methods in which they can provide this information, requesting, collecting, and reviewing the Scorecard receipt and data to identify concerns relative to service performance metrics
  • Develop corrective action plan for deficiency items
  • Delivery and review of updated Admin Manual
  • PRA must meet with payers three times annually, preferably face to face, but telephonically if appropriate based on payer preference.


Qualifications:
  • College degree or equivalent work experience.
  • Experience working Federal and/or Taft Hartley clients
  • Demonstrated excellent oral, written, interpersonal, analytical, and negotiation skills.
  • Ability to use PC software and multiple Cigna systems.
  • Understanding of medical insurance products and associated HCP issues
  • Strong communications skills - both interpersonal and written
  • Ability to work in a matrix environment.
  • Travel required


This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

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.