Encore -Clinical RN High Cost Claimant Analyst -Remote

📋 Description

• • Review high cost claimant reports provided by Client Management, clinical value analytics, and Underwriting teams to extract actionable clinical insights.
• • Analyze clinical and claims data including diagnoses, claim history, current clinical status, and potential future claim impact to support internal business decisions.
• • Prepare clear, concise clinical summaries and reports that translate complex medical information into business-relevant findings for Sales, Client Management, and Underwriting teams.
• • Utilize Cigna and CGHB clinical documentation and reporting systems to access, review, and interpret clinical notes and claims records.
• • Participate in regular meetings and conference calls to discuss high cost claimant trends, provide follow-up information, and align on clinical interpretations.
• • Support daily, weekly, and monthly reporting cycles for high cost claimants with accuracy and timeliness.
• • Apply independent clinical judgment and discretion when handling sensitive patient data and confidential claims information.
• • Partner effectively with both clinical and non-clinical internal stakeholders to ensure alignment on claimant assessments and business needs.
• • Manage variable workloads and meet time-sensitive deadlines in a fast-paced, remote environment.
• • Maintain strong organizational skills to prioritize multiple concurrent tasks and ensure consistent quality in all deliverables.
• • Demonstrate a customer-focused approach when engaging with internal partners to deliver value-driven clinical insights.
• • Apply analytical thinking to identify patterns, risks, and opportunities within high cost claimant data.
• • Communicate complex clinical findings clearly and professionally through written summaries and verbal discussions.
• • Operate with sound independent judgment in ambiguous or high-pressure business situations.
• • Adhere to Cigna’s policies and protocols for handling protected health information and internal reporting standards.