Network Operations Rep for Cigna

Some responsibilities include:

Description

Support the HS Net Ops Sr. Analyst role. Below are specific tasks they perform on an ongoing basis:

– Process all new incoming applications & contracts from all locations of market

– Process ACD (Add, Change, Delete) notifications for the large delegated groups that have been assigned on a monthly basis

– Maintain provider contract files (permanent files) and system information on an ongoing basis

– Prepare &/or copy meeting packets, HEDIS/STAR packets, orientation packets, and provider educational memos as needed

– Assist with provider calls for claims questions, enrollment questions, referral questions, etc as needed for the North East Texas market

– Research and resolve provider issues for claims for the market as needed

– Manage the HS Connect email requests, daily

– Update Directory Addendums for all H plans (preferred health plans) on a monthly basis, or as needed

– Assist with any fax notifications for Admits, ER visits, or any other Health Services educational documentation throughout the year.

– Work with HS Net Ops Sr. Analysts team as needed to focus on daily ADK (Admits per Thousand), monthly top 1% membership report, and monthly catastrophic report (all year)

– Assist in the development and mailing of any termination letters for provider network

– Manage the Network Interest Process & participate in QIC (quality improvement committee) meeting monthly

– Review the Credentialing Internal SharePoint site page every week for any newly credentialed provider. Once identified, print out profile and give to appropriate Net Ops Rep for processing

Qualifications

US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at SeeYourself@cigna.com.

Qualifications

High School Diploma or equivalent

Bachelor’s Degree preferred

Proficient at Microsoft Office products and learning reporting applications

Excellent communication, verbal and written skills

25% local Travel within East Texas/Lufkin service area