Job Information
The Cigna Group Claims Manager - Evernorth - Hybrid in Philadelphia, Pennsylvania
POSITION SUMMARY
The Claims Manager is responsible for managing the day-to-day activities of claims supervisors, strategies, metric performance/quality expectations for an assigned claim platforms. The claims manager will work very closely and collaboratively with many matrix partners to manage inventory, capacity, global service partners (GSPs), and peers to ensure competent and adequate staffing to achieve defined performance and quality metrics.
Primary Responsibilities
Accountable for supervisor performance in managing claim advocates to drive and maintain claim inventory efficiently and accurately across multiple claim types.
Manages overall operational performance through eMOS review of attainment and quality performance and development of action plans to remediate issues.
Engages and communicates with matrix partners (e.g., RMG, capacity planning, GSPs, etc.) to develop strategic plans to increase performance and to remove operational challenges and barriers.
Develops and fosters a positive team culture to drive results through communication, inclusion, engagement, and development of supervisors and direct reports.
Leverages managerial courage in performance management discussions and consistently delivers accurate and transparent messages to staff
Responsible for the strategic analysis of eMOS data to gain deep insights in order to proactively recommend improvements related to eMOS tools, team results and processes to drive operational efficiencies and improvements across aligned organization.
Address eMOS 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.
Accountable for meeting performance requirements in dedicated and performance guaranteed accounts, including accounts with late payment interest requirements
Identify and facilitate mid to large scale operational improvement opportunities impacting quality, accuracy, and efficiency.
Facilitates compliance with state regulations and (as applicable) SOX and SOC compliance requirements.
Responsible for effectively communicating verbally and in writing to senior leaders in the organization and in disseminating information to staff.
Providing mentoring and coaching to supervisors to meet or exceed goals successfully.
Key Qualifications
High School Diploma or GED required; Bachelor’s degree preferred.
5 years relevant operations experience
2+ years of supervisory experience, with a preference to supervising claims processors. Leverage managerial courage through difficult employee performance and management situations.
2+ years of claims management experience, including auto-adjudication, quality, and/or metric score card management, with a preference to Management Operating Systems (eMOS) tools and methodologies.
2+ years experience coaching, training and/or supporting employees to drive accuracy and performance results.
Strong communication skills and the ability to communicate appropriately at all levels of the organization; this includes written and verbal communications as well as visualizations.
Proven ability to manage improvement projects from opportunity identification, solutioning, and implementation.
Effectively lead change through communication, and leadership
Excellent analytical, problem-solving, and issue prioritization abilities.
Resolve issues/mitigate risks in a timely manner/with sense of urgency
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.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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.
Qualified applicants with criminal histories will be considered for employment in a manner
consistent with all federal, state and local ordinances.
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.