Claims Systems Lead Analyst - EviCore - Remote
Read straight from The Cigna Group's careers page, verified 1d ago.Seekless can tailor your résumé to it.
Seekless can write your résumé for this posting first.
Before you apply
LocationFranklin, TN
Work moderemote · United States
Typefull-time
SeniorityLead
Experience5+ yrs
Company size10,000+ people
PostedOct 8, 2026 · 3w ago
Verified live1d ago
At a glanceSummarised by Seekless from the posting.
5+ years of claims and health care experience required
Experience running complex queries utilizing Microsoft SQL
Proficient in Microsoft Access Database (including queries and data manipulation) is required
Proficient in Microsoft Excel (including pivot tables, charts and formulas) is required
Strong technical competence, proven critical thinking, and impeccable communication skills are required
Accomplished in claims lifecycle knowledge and claims adjudication framework
Industry standard claims data types and editing rules (ICD, CPT/HCPC, Rev Codes, NCCI)
Creating test plans/use cases, and SDLC models
Bachelor Degree in a computer related field preferred or equivalent work experience
5+ years of experience in medical Claims Systems Configuration preferred
Familiarity with database management systems (DB2, SQL Server)
External client facing experience preferred
Skills
Microsoft SQL
Microsoft Access
Microsoft Excel
DB2
SQL Server
Azure DevOps
ICD
CPT/HCPC
Rev Codes
NCCI
SQL
Summary:
This position is responsible for all related aspects of the claims systems processes. For this essential, fast-paced Claims Systems role, you will manage complex Claims Systems projects and implementations within the claims adjudication engine. Will ensure data integrity, data security and process optimization for EviCore Claims processing. In addition, you will perform documentation and development of application functionality and data configuration.
Responsibilities:
· Works independently and complete tasks with minimal supervision
· Work from Azure Dev ops utilizing project methodologies to maintain and upkeep tickets for Claim System projects and requests
· The Lead analyst will mentor the Sr. Analyst on complex enhancement and configuration designs
· Provide support as a Claim Systems subject matter expert to internal departments such as but not limited to Claims Configuration, Client Engagement, Program leads, Claims IT Development team
· 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 (such as provider, member, authorizations, claims, etc.)
· Create test/use cases, perform SI testing, and provide support for associated UA testing in order to successfully complete EviCore claims systems client implementations, internal integration/migration efforts.
· Create simple to complex SQL queries to review Claim system configuration and claims data
· Make updates to configuration via Access Database
· Run Postproduction review on claims to validate changes deployed to production are processing as expected
· Investigate claim processing to determine Claim Configuration root cause analysis
· The associate will be responsible for collaboration and oral/written communication with internal and external client business operations, IT departments and QA departments to support these requirements.
· Additional responsibilities may include assisting the reporting development team, RFP data processing requests, training, maintenance transition and process/product workflow/documentation.
· This associate will perform duties under self-direction and is expected to make decisions as necessary.
Requirements:
· Bachelor Degree in a computer related field preferred or equivalent work experience
· 5+ years of claims and health care experience required
· 5+ years of experience in medical Claims Systems Configuration preferred
· Experience running complex queries utilizing Microsoft SQL
· Proficient in Microsoft Access Database (including queries and data manipulation) is required
· Proficient in Microsoft Excel (including pivot tables, charts and formulas) is required
· Strong technical competence, proven critical thinking, and impeccable communication skills are 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)
· External client facing experience preferred
· Creating test plans/use cases, and SDLC models.
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 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.
Legal
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 need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.