The Cigna Group logo
The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Claim Negotiator - Non-Par Reimbursement

Reimbursement SpecialistGeneralOtherRemoteMid LevelTeam 10,001+Since 1982H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

2 days ago

Salary

$58.1K - $96.9K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Claim Negotiator - Non-Par Reimbursement

The Cigna Group

Role Description The job profile for this position is Provider Relations Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. This role is an individual contributor within the Nonpar Provider Contracting Team, supporting our enterprise strategy to deliver affordable, predictable, and simple health care. The position is responsible for: - Negotiating nonpar single case agreements - Ensuring compliance - Fostering strong partnerships with internal and external stakeholders Summary of Responsibilities: - Skillfully navigate reimbursement conversations with nonpar health care professionals while providing exceptional service - Negotiate reimbursement rates for nonpar health care providers - Utilize excellent verbal and written communication skills - Partner with internal teams to resolve complaints and disputes - Ensure compliance with policies, procedures, and regulatory requirements - Suggest process improvements and foster innovation - Utilize knowledge of medical terminology and standard reimbursement methodologies - Manage multiple priorities in a fast-paced environment Key Duties and Responsibilities: - Review and prioritize daily work assignments for timely single case agreement negotiation - Develop individual case pricing strategies and present to management and/or providers - Accurately document case outcomes in all systems and communicate results to stakeholders - Serve as team subject matter expert (SME) for highly complex cases - Support department goals contributing to organizational success - Communicate and collaborate effectively with internal and external partners - Adhere to all Compliance/Program Integrity requirements and HIPAA regulations - Promote professional growth through continuing education and skills development Qualifications - Minimum 2+ years of experience in healthcare contracting, provider relations, or reimbursement negotiations required - Single case agreement or billing negotiation experience required - Demonstrated experience in interpreting and applying reimbursement methodologies - Proficiency in medical terminology and healthcare industry standards - Strong negotiation and conflict resolution skills - Advanced proficiency in Microsoft Office Suite (Excel, Word, Outlook) - Ability to manage multiple priorities in a high-volume environment Requirements - 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 Benefits - Comprehensive range of benefits, with a focus on supporting your whole health - 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 and leaves of absence - Eligibility to participate in an annual bonus plan

Related Job Pages

More Reimbursement Specialist Jobs

Full TimeRemoteTeam 11-50H1B No Sponsor

• Educating providers and their office staff on access and reimbursement topics using client-approved resources • Supporting appropriate patient access to the client’s products by resolving reimbursement and coverage challenges • Collaborating with other patient assistance and reimbursement support services offered by the client • Meeting directly with healthcare providers and their office staff to provide education on reimbursement and access considerations • Delivering interactive educational presentations at various provider sites of service

Florida
Merit Medical Oncology logo

Senior Reimbursement Specialist

Merit Medical Oncology

We're on a Mission to Ease the Burden Cancer Places on Patients and Their Loved Ones. #BreastSurgery #PatientCare

Full TimeRemoteTeam 5,001-10,000Since 1987H1B No Sponsor

• Executes and optimizes US reimbursement strategies that support business objectives across prioritized product and therapy areas. • Provides reimbursement and health policy guidance to product development, working in close partnership with clinical, regulatory, marketing, and sales teams. • Partners with HEOR to assess global evidence needs and support development of payer‑relevant data. • Analyzes reimbursement landscapes and contributes to coding, coverage, and payment pathway development including evaluation of relevant data analytics pertaining to health policy initiatives. • Educates internal leaders and field teams on reimbursement requirements and business impact. • Builds and maintains relationships with payers, government agencies, professional societies, and advocacy groups. • Identifies reimbursement barriers, develops initiatives, and supports implementation of programs that improve market access. • Designs and delivers reimbursement education for internal and external stakeholders. • Represents, as a leader, the expertise and perspective of the Reimbursement/Market Access function to the business divisions it supports. • Performs other duties, as required.

Utah
Merit Medical Oncology logo

Senior Reimbursement Specialist

Merit Medical Oncology

We're on a Mission to Ease the Burden Cancer Places on Patients and Their Loved Ones. #BreastSurgery #PatientCare

Full TimeRemoteTeam 5,001-10,000Since 1987H1B No Sponsor

• Supports execution of reimbursement strategies aligned with business priorities and product lifecycle needs • Provides reimbursement and health policy guidance to clinical, regulatory, marketing, and sales partners • Contributes to evidence planning by partnering with HEOR to identify payer‑relevant data needs • Analyzes reimbursement landscapes and supports development of coding, coverage, and payment pathways and internal and external communication tools • Educates internal teams on reimbursement requirements, payer trends, and implications for product adoption • Identifies reimbursement barriers and supports implementation of solutions to improve patient access • Develops and delivers reimbursement education for internal teams and external stakeholders • Performs other duties, as required

United States
UBC logo

Senior Reimbursement Specialist

UBC

Patients First. Powered by Evidence.

Full TimeRemoteTeam 1,001-5,000Since 2003H1B No Sponsor

• Provide high quality customer service • Effectively interface with patients, patient’s families, national payers, home cares and medical doctor’s offices • Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices • Submit and obtain prior authorizations as required by payer • Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval • Accurately enter and maintain data as required in client database and patient files • Utilize the client database to monitor outstanding items on each client case file • Ensure files are complete so team can determine the current status • Participate in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases • Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient • Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies • Educate patients, prescribers, and others regarding program requirements, and facilitate referrals • Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures

United States