Clinical RN High Cost Claimant Analyst
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Job Description
Clinical RN High Cost Claimant Analyst analyzing high cost claimant reports to support internal teams at Cigna's Encore program. Requires active RN license and CCM certification or BSN preference.
Responsibilities:
- Review high cost claimant reports from Client Management, clinical value analytics, and Underwriting teams.
- Analyze clinical and claims information, including diagnoses, claim history, current clinical status, and potential future claim impact.
- Prepare clear clinical summaries and reporting that support internal business partners and client-related discussions.
- Review clinical documentation and notes using applicable Cigna and CGHB clinical documentation and reporting systems.
- Participate in meetings and conference calls to discuss high cost claimant reports, trends, and requested follow-up information.
Requirements:
- Active Unencumbered Registered Nurse license in state of residence.
- Certified Case Manager (CCM) certification or Bachelor of Science in Nursing (BSN) strongly preferred.
- Case management experience and claims payer experience.
- Experience reviewing high cost claims, clinical documentation, and claims history.
- Ability to use clinical documentation and reporting systems, including Cigna and CGHB systems.
- Demonstrated ability to work independently, manage variable workloads, and meet time-sensitive deadlines.
- Experience communicating with clinical and non-clinical partners, including Sales, Client Management, and Underwriting.
Benefits:
- Flexible work arrangements
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