# Claims Systems Lead Analyst

**Company**: Evernorth Health Services
**Location**: Franklin, TN
**Experience**: senior
**Job type**: full-time
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cigna.wd5.myworkdayjobs.com/en-US/cignacareers/job/Franklin-TN/Claims-Systems-Lead-Analyst---EviCore---Remote_26012598?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_9435b705-7be

## Description

We are seeking a Claims Systems Lead Analyst to manage complex Claims Systems projects and implementations within the claims adjudication engine. You will ensure data integrity, data security, and process optimization for EviCore Claims processing. Additionally, you will perform documentation and development of application functionality and data configuration.

Responsibilities:

- Work independently and complete tasks with minimal supervision

- Utilize Azure DevOps to maintain and update tickets for Claim System projects and requests

- Mentor the Senior Analyst on complex enhancement and configuration designs

- Provide support as a Claim Systems subject matter expert to internal departments

- Lead external client calls to support clients in all aspects of the Claim System application

- Define business, technical, and claim data exchange requirements

- Instruct on data file mapping

- Create test/use cases, perform SI testing, and provide support for associated UA testing

- Create simple to complex SQL queries to review Claim system configuration and claims data

- Make updates to configuration via Access Database

- Run post-production reviews on claims to validate changes deployed to production

- Investigate claim processing to determine Claim Configuration root cause analysis

- Collaborate and communicate with internal and external client business operations, IT departments, and QA departments

Requirements:

- Bachelor's degree in a computer-related field preferred or equivalent work experience

- 5+ years of claims and healthcare experience required

- 5+ years of experience in medical Claims Systems Configuration preferred

- Experience running complex queries utilizing Microsoft SQL

- Proficient in Microsoft Access Database and Microsoft Excel

- Strong technical competence, proven critical thinking, and impeccable communication skills required

- Accomplished in claims lifecycle knowledge and claims adjudication framework

- Industry standard claims data types and editing rules (ICD, CPT/HCPC, Rev Codes, NCCI)

- Familiarity with database management systems (DB2, SQL Server)

## Skills

### Required
- Microsoft SQL
- Microsoft Access Database
- Microsoft Excel
- SQL Server
- DB2
- ICD
- CPT/HCPC
- Rev Codes
- NCCI

### Nice to have
- External client facing experience
- Creating test plans/use cases
- SDLC models

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Source: [Apply at cigna.wd5.myworkdayjobs.com](https://cigna.wd5.myworkdayjobs.com/en-US/cignacareers/job/Franklin-TN/Claims-Systems-Lead-Analyst---EviCore---Remote_26012598?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)