Cigna
Appeals Processing Analyst- RN
This job is now closed
Job Description
- Req#: 24016328
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Full-time position with a stable schedule of 40 hours/week, Monday through Friday, with alternating weekends as required
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on member satisfaction and healthcare outcomes
- Work independently while having access to experienced team members for guidance
What to Expect (Job Responsibilities):
- Complete day-to-day Utilization Review tasks with minimal supervision while resolving non-routine issues escalated from junior team members
- Review and research claims and requests for plan services submitted by members and providers to determine reasons for denial
- Make administrative determinations on appeals and provide detailed clinical summaries for the Plan Medical Director
- Communicate appeal information to members and providers within required timeframes
- Adhere to department workflows, policies, and performance goals related to efficiency, accuracy, and quality
What is Required (Qualifications):
- Active RN license
- 3-5 years of experience in Medicare Advantage Health Plans or related healthcare setting handling complex inquiries and requests
- Working knowledge of Medicare Advantage, Original Medicare, and Medicaid appeal regulations
- Superb written and oral communication skills with the ability to present case summaries and decisions clearly
- Proficient in Microsoft Office products (Access, Excel, PowerPoint, Word)
How to Stand Out (Preferred Qualifications):
- Experience with claims processing and application of member benefits related to the Explanation of Coverage
- Ability to work independently and under pressure while maintaining attention to detail
- Critical thinking skills and the ability to identify trends or areas of opportunity in case work
#HealthcareServices #UtilizationManagement #CareerOpportunity #RNJobs #MedicareAdvantage
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Cigna is an American worldwide health services organization based in Bloomfield, Connecticut.
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