Description
The Provider Data Lead Representative is responsible for ensuring the accurate maintenance, correction, and integrity of provider data to support overall network quality.
This role involves managing provider information across core systems, including HCPM, CPF, and Facets, through timely updates, corrections, and terminations.
The position is also accountable for resolving claim, demographic, and contract-related fallout to prevent recurrence, enhance data accuracy, and improve the overall customer and provider experience.
Key Responsibilities:
- Execute provider data additions, terminations, and updates in accordance with established procedures and business needs.
- Perform data remediation activities within HCPM, CPF, and Facets to maintain system accuracy and consistency.
- Implement updates identified through quality audits and performance analyses to improve data integrity.
- Apply contract terms and network business rules to ensure accurate and compliant data outcomes.
- Identify operational risks and issues encountered during data load processes and take appropriate corrective action.
- Validate data accuracy across multiple systems and ensure successful transmission to downstream platforms.
- Conduct root cause analysis to diagnose issues and implement solutions aligned with desired outcomes.
- Analyze intake requests from matrix partners to assess impact and execute appropriate provider, network, or criteria-level updates across systems.
- Adhere to established production and quality standards, including accurate and timely documentation in the Daily Activity Log (DAL).
- Support system enhancement initiatives by participating in testing, validation, and checkout activities as directed.
- Collaborate effectively within a team environment while maintaining accountability for individual contributions and results.
Qualifications:
- High school diploma or GED required; some college coursework preferred.
- 2+ years of demonstrated proficiency using CPF and HCPM required (Proclaim and Facets preferred).
- Strong understanding of data flow and downstream system impacts.
- Knowledge of provider structures, including Practitioners, Groups, Facilities, and Ancillaries required.
- Solid understanding of contracts, networks, and applicable Market Guidebook standards is highly preferred.
- Working knowledge of tools such as DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, and Knowledge Exchange is highly preferred.
Competencies:
- Adaptability & Learning Agility
- Problem Solving & Critical Thinking
- Communication & Collaboration
- Execution & Productivity
The role is anticipated to be eligible to participate in an annual bonus plan.
The Cigna Group offers a comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs, 401(k), company-paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.