Claims Systems Lead Analyst

The Cigna Group

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

Posted 10/8/2026full-timeRemote • Tennessee • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Claims Systems Management, including configuration, data integrity, and process optimization. Proficient in SQL and Access Database for data manipulation and analysis, with strong communication skills for client engagement and collaboration.

Highest-signal resume keywords

Claims Systems ConfigurationMicrosoft SQLMicrosoft Access DatabaseClaims Lifecycle KnowledgeClient-Facing Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims Systems ManagementData IntegrityProcess OptimizationSQL QueriesData File MappingTest Plans/Use CasesSDLC ModelsClaims Adjudication FrameworkClaims Data TypesRoot Cause Analysis

Soft Skills

Critical ThinkingCommunication SkillsMentoring

Tools & Technologies

Azure DevOpsMicrosoft ExcelDB2SQL Server

Industry Keywords

Claims ProcessingHealth Care ExperienceICDCPT/HCPCRev CodesNCCI

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 update tickets for Claims System projects and requests
Mentor the Senior Analyst on complex enhancement and configuration designs
Provide Claims Systems subject matter expertise to internal departments, including Claims Configuration, Client Engagement, Program Leads, Claims IT Development, and QA
Lead external client calls and support clients in all aspects of the Claims System application
Define business, technical, and claims 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 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 production 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
Proficient in Microsoft Excel, including pivot tables, charts and formulas
Strong technical competence, proven critical thinking, and impeccable communication skills
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
Ability to obtain home internet through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload

Benefits

Comp & perks

Remote work arrangement
Internet connection through a cable broadband or fiber optic internet service provider with minimum speeds of 10Mbps download/5Mbps upload when working from home
Equal employment opportunity protections
Reasonable accommodation support for the online application process
Tobacco/nicotine cessation program eligibility in applicable states