Claims Systems Lead Analyst

The Cigna Group

. Manage complex Claims Systems projects and implementations within the claims adjudication engine .

Posted 10/9/2026full-timeRemote • Tennessee • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Claims Systems Configuration and management, with strong capabilities in SQL query creation, data integrity, and process optimization. Proven ability to mentor teams and communicate effectively with internal and external stakeholders.

Highest-signal resume keywords

Claims Systems ConfigurationSQL Query CreationMicrosoft Access DatabaseClaims Lifecycle KnowledgeData Integrity and Security

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

SQLClaims AdjudicationData MappingTest Case DevelopmentData ConfigurationProcess OptimizationClaims Data AnalysisSDLC ModelsData ManipulationClaims Processing

Soft Skills

Critical ThinkingCommunicationMentoringCollaborationClient Engagement

Tools & Technologies

Microsoft AccessMicrosoft ExcelAzure DevOpsDB2SQL Server

Industry Keywords

Claims SystemsHealthcare ExperienceICD CodesCPT/HCPC CodesRev CodesNCCIClaims LifecycleData SecurityData IntegrityClaims Configuration

Tech Stack

Tools & technologies

AzureSDLCSQL

About the role

Key responsibilities & impact

Manage complex Claims Systems projects and implementations within the claims adjudication engine
Ensure data integrity, data security, and process optimization for EviCore Claims processing
Document and develop application functionality and data configuration
Work from Azure DevOps using project methodologies to maintain and upkeep tickets for Claims System projects and requests
Mentor Senior Analysts on complex enhancement and configuration designs
Provide Claims Systems subject matter expertise to Claims Configuration, Client Engagement, Program Leads, Claims IT Development, and other internal departments
Lead external client calls supporting all aspects of the Claims System application
Define business, technical, and claim data exchange requirements
Instruct on data file mapping for providers, members, authorizations, claims, and related data
Create test/use cases, perform SI testing, and support associated UA testing for client implementations and internal integration/migration efforts
Create simple to complex SQL queries to review Claims System configuration and claims data
Update configuration through Access Database
Conduct postproduction claims reviews to validate deployed changes
Investigate claim processing and perform Claims Configuration root cause analysis
Collaborate and communicate with internal and external business operations, IT, and QA departments
Assist reporting development, RFP data processing requests, training, maintenance transition, and process/product workflow documentation
Perform duties under self-direction and make decisions as necessary

Requirements

What you’ll need

Bachelor Degree in a computer related field preferred or equivalent work experience
5+ years of claims and health care experience required
5+ years of experience in medical Claims Systems Configuration preferred
Experience running complex queries utilizing Microsoft SQL
Proficient in Microsoft Access Database, including queries and data manipulation, required
Proficient in Microsoft Excel, including pivot tables, charts and formulas, required
Strong technical competence, proven critical thinking, and impeccable communication skills required
Accomplished in claims lifecycle knowledge and claims adjudication framework
Knowledge of industry standard claims data types and editing rules, including ICD, CPT/HCPC, Rev Codes, and NCCI
Familiarity with database management systems, including DB2 and SQL Server
External client-facing experience preferred
Experience creating test plans/use cases and SDLC models
For home work, internet connection must be through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload

Benefits

Comp & perks

Remote work option (occasionally or permanently), subject to cable broadband or fiber optic internet with at least 10Mbps download/5Mbps upload
Tobacco-free policy; qualifying smoking cessation program may be available where legally permissible
Equal employment opportunity
Reasonable accommodation for the online application process