Want to Drive Growth and Improve Lives? EviCore a division of The Cigna Group is hiring several Claims Quality Assurance, level 1 Auditors. For this essential role, you'll be responsible for the review, development and performing internal audit procedures and preparing internal audit reports reflecting the results of the work performed. You'll ensure continuous quality improvement in reviewing claims for accuracy, and that payment and fee schedules are in compliance with policies and procedures.
How you'll make a difference:
Audit claims to ensure accuracy, payment and if errors exist, follow established guidelines to correct errors, assess accuracy and provide feedback
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Responsible for ongoing improvement of quality standards to ensure accuracy and compliance for Claims Operations and Record Maintenance
Work with management and staff to establish and maintain audit and quality assurance programs
Assist in maintaining and developing policies and procedures and training documentation for contract administration
Ensure adherence to company guidelines and policies in contract administration and claims processes.
Collaborates with Supervisor and Subject Matter Expert related to claim audits.
Performs other job-related duties or special projects as assigned
What you need to Succeed :
High School Diploma or GED required, associate's degree preferred
1 + years of experience in claims processing required
1+ years of experience in billing and medical terminology required
1 + years of experience in Quality Assurance preferred
1 + years of experience working with at least 2 health plans, preferred
Proficiency in data entry and MS Excel required
Experience in MC400, ImageOne, Issac and plexus systems experience strongly preferred
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 17 - 24 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 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: 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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