Claim Negotiator - Non‑Par Reimbursement - Remote
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AI Summary
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We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
This role is an individual contributor within the Nonpar Provider Contracting Team, supporting our enterprise strategy to deliver affordable, predictable, and simple health care. The position is responsible for negotiating nonpar single case agreements, ensuring compliance, and fostering strong partnerships with internal and external stakeholders.
Summary of Responsibilities
The Provider Relations Sr. Analyst skillfully navigates reimbursement conversations with nonpar health care professionals while providing exceptional service. Responsibilities include negotiating reimbursement rates for nonpar health care providers, utilizing excellent verbal and written communication skills, partnering with internal teams to resolve complaints and disputes, ensuring compliance with policies, procedures, and regulatory requirements, suggesting process improvements and fostering innovation, utilizing knowledge of medical terminology and standard reimbursement methodologies, and managing multiple priorities in a fast-paced environment.
Key Duties and Responsibilities
Review and prioritize daily work assignments for timely single case agreement negotiation.
Develop individual case pricing strategies and present to management and/or providers.
Accurately document case outcomes in all systems and communicate results to stakeholders.
Serve as team subject matter expert (SME) for highly complex cases.
Support department goals contributing to organizational success.
Communicate and collaborate effectively with internal and external partners.
Adhere to all Compliance/Program Integrity requirements and HIPAA regulations.
Promote professional growth through continuing education and skills development.
Qualifications
Minimum 2+ years of experience in healthcare contracting, provider relations, or reimbursement negotiations required
Single case agreement or billing negotiation experience required
Demonstrated experience in interpreting and applying reimbursement methodologies.
Proficiency in medical terminology and healthcare industry standards.
Strong negotiation and conflict resolution skills.
Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook).
Ability to manage multiple priorities in a high-volume environment.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
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.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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