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Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Manager, Claims Business Rules Configuration
Location
Illinois
Posted
109 days ago
Salary
$87.1K - $145.1K / year
Seniority
Lead
Job Description
Manager, Claims Business Rules Configuration
The Cigna Group
• Oversee daily operations and performance of the Claims Systems Configuration team • Develop, track, and report on departmental KPIs • Ensure accurate and optimized claims processing through strong data integrity and continuous process improvement • Provide approval for configuration deployments, documentation, and training materials • Maintain departmental audit controls and partner with Compliance to ensure readiness for internal or external audits • Lead the design and implementation of claim business rule configurations, including clinical and admin policy, benefit, provider, and authorization rules • Manage change control, risk assessments, issue resolution, and progress reporting • Support the refinement activities of configuration requests and design align with approved requirements • Recommend system improvements to increase auto-adjudication rates and streamline claims processing • Oversee development and maintenance of departmental work instructions, policies, and workflows • Ensure effective training materials are created and maintained for configuration processes • Conduct and oversee audits to ensure adherence to processes and documentation standards • Motivate and guide the team to meet performance expectations and departmental goals • Support Supervisors and Trainers in developing staff knowledge and capabilities • Assist with personnel management activities, including hiring, performance evaluations, and disciplinary actions • Provide escalation support for complex configuration or client issues • Partner with governance and process improvement teams to refine workflows and remove impediments • Collaborate with internal teams to provide education on system configuration and support corrective action responses • Ensure knowledge transfer across departments and support broader organizational initiatives
Job Requirements
- High school diploma required
- Bachelor’s degree in healthcare or computer related field preferred
- 5+ years’ experience of business rule configuration in a claims adjudication platform, to include clinical and admin policy rules, provider contract rates and benefit management
- 7+ years’ experience in healthcare claims life cycle
- 2+ years of supervisor experience
- Proficiency in Excel, Word and Access, required
- Advanced in Excel, preferred
- Knowledge of SQL Data Query, Power BI, preferred
- Proficiency in Claim Business Rule configuration in a claims adjudication platform, required
- Knowledge healthcare IT claim adjudication systems, claims processing, healthcare data sets (ICD-10, CPT/HCPC, etc.)
- Knowledge of Agile, Kanban, Jira board and dashboard management
- Strong analytical and critical thinking skills, required
- Strong decision-making skills, required
- Strong aptitude for process improvement, required
- Ability to supervise, multitask and work independently in a fast-paced environment are essential skills for this position
Benefits
- health-related benefits including medical, vision, dental, and well-being and behavioral health programs
- 401(k)
- company paid life insurance
- tuition reimbursement
- a minimum of 18 days of paid time off per year
- paid holidays
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