Plan Implementation Sr. Representative - Evernorth - Remote

The Cigna Group

Job Overview

Location

United States Work at Home

Job Type

Full-time

Full Job Description

📋 Description

• The Sr. Representative for Plan Implementation at Evernorth plays a critical role in ensuring the accuracy and integrity of provider data, which directly impacts claims processing, network adequacy, and member access to care. This position supports the National Ancillary Team by resolving data discrepancies, driving process improvements, and maintaining compliance with loading instructions and business policies—making it essential to the seamless operation of healthcare services across the Cigna Group.
• Day-to-day responsibilities include researching and resolving fallout issues related to CIM data and demographics, such as demo changes and fallout, as well as LXNX and other provider data anomalies; working assigned work items from the queue and following up with management on monthly infractions; understanding interdependencies between business systems, teams, and matrix partners to identify when additional analysis or process changes are needed; participating in peer training and coaching to build expertise in provider data nuances; engaging in daily workload balancing to support team priorities and ensure timely completion of tasks; understanding and adhering to all loading instructions, policies, and procedures while proactively identifying and escalating process gaps or inefficiencies that could impact customers; conducting root cause analysis using data trending tools to identify problems and collaborating on corrective actions; meeting deadlines while accepting additional assignments without compromising quality, production, or timeliness standards; collaborating effectively in both team and independent settings; working with matrix partners to deliver regular data performance feedback, close data integrity gaps, and proactively resolve issues.
• The Evernorth team within The Cigna Group is focused on delivering innovative health services that improve affordability, access, and outcomes for clients and patients. As part of a national team supporting provider data operations, this role contributes to a mission-driven organization committed to enhancing health and vitality through integrated solutions in Cigna Healthcare and Evernorth Health Services. The team values collaboration, continuous improvement, and data-driven decision-making in a fast-paced, remote-friendly environment.
• In this role, the individual will develop deep expertise in healthcare provider data systems, including HCPM, Facets, and Proclaim, while strengthening analytical, problem-solving, and communication skills. They will gain experience in process improvement methodologies, cross-functional collaboration, and data integrity management—positioning them for advancement in healthcare operations, data management, or implementation roles within The Cigna Group’s growing health services divisions.

🎯 Requirements

• Associate’s degree or higher, or equivalent work experience
• Prior experience in the healthcare industry with knowledge of medical terminology
• Proficiency in Microsoft Word, Excel, and Access
• Required knowledge of HCPM (Healthcare Provider Management)
• Preferred experience with Facets and Proclaim systems
• Prior claim exposure or experience preferred
• Working knowledge of coding and reimbursement methodologies
• Experience with provider data loading and understanding of how contracts and business policies affect claim payment
• Proven ability to maintain positive working relationships, give and receive feedback, and coach others
• Self-starter with strong technical, analytical, negotiating, problem-solving, organizational, and time management skills
• High aptitude for focus and attention to detail when working with complex data and systems
• Ability to thrive in a fast-paced, demanding environment
• Effective communication skills across diverse audiences and topics
• Capacity to work independently while managing multiple tasks and deadlines, while also being a strong team player and collaborator

🏖️ Benefits

• Comprehensive health benefits starting day one, including medical, vision, dental, and well-being and behavioral health programs
• 401(k) retirement plan with company match
• Company-paid life insurance
• Tuition reimbursement program
• Minimum of 18 days of paid time off per year plus paid holidays
• Eligibility for an annual bonus plan
• Remote work flexibility with requirement for cable broadband or fiber optic internet (10Mbps download/5Mbps upload)
• Tobacco-free workplace policy with support for cessation programs in applicable states
• Commitment to diversity, equity, inclusion, and reasonable accommodations for applicants with disabilities
• Access to employee assistance programs and career development resources

Skills & Technologies

Fiber

Senior

Onsite

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The Cigna Group

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About The Cigna Group

The Cigna Group is a global health services company formed in 1982 through the merger of Connecticut General and INA Corporation. It provides medical, dental, disability, life and accident insurance, pharmacy benefit management, and behavioral health services to employers, individuals and government entities. Headquartered in Bloomfield, Connecticut, the company operates in over 30 countries and jurisdictions, serving more than 180 million customer relationships worldwide through its subsidiaries and affiliates.

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