• Determine denials from remittance /explanation of benefits • Trend root cause and take appropriate steps for resolution by crafting detailed appeal letters • Contact insurance payers for resolution • Ensure legal compliance by following guidelines, account contract, and the company's business plan • Maintain quality service by following corporate customer service practices and protocols • Analyze claims to determine the validity of recovery options • Draft detailed & convincing correspondence to effectuate reimbursement • Contact insurance carriers, patients, attorneys, and employers to facilitate reimbursement • Interpret contracts as it relates to reimbursement, timelines, and verbiage of payer responsibilities guidelines to be followed • Use of payer portals and other technologies to advance time to revenue • Identify defined root causes and trends from client inventories to formulate recovery resolutions or next steps in best practices • Clearly and concisely document all actions taken to the resolution of each claim within a claims recovery system

The job profile for this position is Program Management Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career? 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 plays a critical part in supporting non-participating cost containment efforts by ensuring accurate, timely, and thoughtful manual pricing decisions. You will collaborate with experienced professionals to evaluate complex claims and contribute to solutions that drive consistency, quality, and positive customer outcomes across the organization. Responsibilities - Perform manual pricing for Maximum Reimbursable Charge (MRC1/MRC2) claims, ensuring accuracy, compliance, and alignment with pricing guidelines. - Analyze complex, sensitive, or escalated claims and recommend pricing outcomes that balance cost containment with customer experience. - Evaluate system and process challenges, identifying practical solutions that improve efficiency, accuracy, and overall results. - Provide clear analysis, pricing rationale, and guidance to internal and external partners requesting manual pricing support. - Take informed, decisive action on priority issues while managing multiple requests in a fast-paced environment. - Contribute to continuous improvement by sharing knowledge, strengthening functional expertise, and supporting team learning. - Support quality and accuracy initiatives that enhance appeal outcomes and improve member and provider experiences. Qualifications Required Qualifications - 3+ years of experience in claims analysis, pricing, reimbursement, or related healthcare operations role. - Strong analytical and problem-solving skills, with the ability to assess complex data and make sound recommendations. - Experience working in fast-paced environments requiring prioritization, independent decision-making, and attention to detail. - Strong written and verbal communication skills, with the ability to explain pricing decisions clearly and professionally. - Proficiency with Microsoft Office tools, including Excel, Word, PowerPoint, and SharePoint. Preferred Qualifications - Knowledge of healthcare claim payment methodologies and reimbursement practices. - Experience with claims systems such as Proclaim, PMHS, Facets, or SANP. - Experience supporting pricing strategy, appeals, or reimbursement analysis. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 66,300 - 110,500 USD / yearly, depending on relevant factors, including experience and geographic location. 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 and paid holidays. 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.

At U.S. Bank, we’re on a journey to do our best. Helping the customers and businesses we serve to make better and smarter financial decisions, enabling the communities we support to grow and succeed in the right ways, all more confidently and more often—that’s what we call the courage to thrive. We believe it takes all of us to bring our shared ambition to life, and each person is unique in their potential. A career with U.S. Bank gives you a wide, ever-growing range of opportunities to discover what makes you thrive. Try new things, learn new skills and discover what you excel at—all from Day One. As a wholly owned subsidiary of U.S. Bank, Elavon is committed to building the platforms and ecosystems that help over 1.5 million customers around the world to achieve their financial goals—no matter what they need. From transaction processing to customer service, to driving innovation and launching new products, we’re building a range of tailored payment solutions powered by the latest technology. As part of our team, you can explore what motivates and energizes your career goals: partnering with our customers, our communities, and each other. We actively uphold transparent and fair hiring practices that support individual opportunity, inclusive culture, and career mobility across all levels of our organisation. We offer meaningful opportunities for growth, a culture of inclusion, and a strong commitment to transparency and integrity in everything we do. Job Description The Fraud Support Analyst provides operational and analytical support to fraud strategy, with a primary focus on system testing and issue resolution in partnership with vendors. This role is responsible for performing system testing and analysis, executing procedures and controls on owned systems, and ensuring all activities align with documented standards and established processes. Acting as the primary point of contact for system-related issues, the analyst monitors, tracks, and coordinates resolution efforts with internal stakeholders and external vendors. The role partners closely with stakeholders, team members, and management to resolve issues, improve processes, maintain strong operational controls, communicate system status, performance, and risks to support the bank’s fraud risk capabilities. Key Responsibilities · Perform system testing and analysis to support fraud platforms and ensure functionality aligns with documented requirements, approved standards and regulatory expectations. · Execute and monitor operational procedures and controls on assigned systems to ensure compliance, accuracy, and audit readiness. · Serve as the primary point of contact for system-related issues, including identification, tracking, escalation, and resolution. · Partner with internal stakeholders and external vendors to coordinate issue resolution, communicate impacts, and drive timely outcomes. · Own vendor-related issues by tracking progress, and ensuring closure in accordance with established processes. · Maintain accurate documentation for system changes, testing, issue resolution, and operational procedures. · Act as a liaison between stakeholders, team members, and management to communicate system status, performance, risks, and issues. · Support initiatives to improve processes, strengthen operational controls, and enhance the bank’s fraud risk capabilities. · Participate in cross-functional meetings and working sessions to ensure alignment, transparency, and continuous improvement. Basic Qualifications - Bachelor’s or equivalent work experience - Three to five years of related experience, this includes testing experience - Ability to manage multiple tasks/projects and deadlines simultaneously - Ability to work as part of a project team - Proficient computer skills, especially Microsoft Office applications and data analysis software This role is designated as U.S. home-based remote. working hours: 2pm-10pm Accessibility We are committed to providing an inclusive and accessible recruitment experience. If you need adjustments at any stage of the application or hiring process, please contact your recruiter for guidance and support. Total Rewards U.S. Bank is committed to fair, equitable, and transparent compensation practices in line with local regulatory and legal requirements. Our total rewards approach is designed to attract, retain, and support top talent while ensuring equal pay for work of equal value. We offer a market-competitive compensation package that includes: - Clearly defined salary ranges aligned with industry benchmarks and internal equity standards. - Performance-based incentives for eligible employees (as defined by relevant plan rules), awarded through transparent, objective criteria that recognize both individual and company performance. - Inclusive equitable benefits that are accessible to all employees and focused around our 3 main pillars of financial wellbeing, health & wellness). - Continuous development opportunities including training, education support, and career progression pathways based on inclusive and transparent criteria. - Employee recognition programs that celebrate achievements and milestones for all. We regularly review our compensation and benefits to ensure they remain competitive, inclusive, and responsive to employee needs and market trends. Further details of the compensation package will be provided upon application. We encourage candidates to explore the full value of our offer, including monetary and non-monetary benefits, at Employee benefits and development | U.S. Bank | Elavon. Closing Date Posting may be closed earlier due to high volume of applicants. We aim to provide timely updates throughout the process and encourage early applications to ensure consideration.

This is a remote position. We are seeking an experienced Facets Configuration Analyst to support the configuration, maintenance, and optimization of the Facets platform. This role is responsible for ensuring accurate claims adjudication by building and maintaining system rules, benefit plans, and operational parameters in alignment with business and regulatory requirements. Key Responsibilities: - Configure and maintain Facets system rules, benefits, and parameters to support claims processing and operational workflows - Ensure accurate and compliant claims adjudication through proper system configuration - Translate business and regulatory requirements into effective system solutions - Analyze and troubleshoot configuration issues, identifying root causes and implementing resolutions - Collaborate with cross-functional teams including operations, compliance, and IT to support system updates and enhancements - Maintain documentation related to configurations, processes, and system changes - Support ongoing system optimization and performance improvements Requirements Required Qualifications: - Minimum of 5 years of hands-on experience with the Facets platform - At least 3 years of experience working with CMS work products, including Medicare Advantage (MA) or Medicaid - Proficiency in a minimum of three Facets modules, including Facets Medical Plan - Experience working with Facets version 25.1 or newer - Strong understanding of healthcare payer operations and claims adjudication processes - Excellent communication skills, both written and verbal