Individual & Family Plans (IFP) Claims Strategy and Payment Integrity Senior Manager

At Cigna, we are dedicated to improving the health and well-being of our customers and communities. We are currently seeking a highly motivated and experienced individual to join our team as the Individual & Family Plans (IFP) Claims Strategy and Payment Integrity Senior Manager. In this role, you will be responsible for developing and implementing strategies to ensure accurate and efficient claims processing for our IFP plans. You will also lead a team in identifying and preventing potential fraud, waste, and abuse in claims payments. The ideal candidate will have a strong background in claims management and payment integrity, as well as excellent leadership skills. If you are passionate about making a positive impact in the healthcare industry and possess the necessary qualifications, we invite you to apply for this exciting opportunity.

Responsibilities: Develop and implement strategies to ensure accurate and efficient claims processing for IFP plans. Lead a team in identifying and preventing potential fraud, waste, and abuse in claims payments. Monitor and analyze claims data to identify trends and opportunities for improvement. Collaborate with cross-functional teams to identify and resolve claims issues and improve processes. Develop and implement training programs for claims staff to ensure understanding and compliance with payment integrity policies and procedures. Conduct audits and reviews to ensure compliance with regulatory standards and internal policies. Monitor industry trends and changes in regulations related to claims processing and payment integrity, and make recommendations for adjustments to processes and procedures. Provide regular reports and updates to senior management on claims processing and payment integrity performance. Develop and maintain relationships with external partners and vendors to support payment integrity efforts. Mentor and coach team members to support their professional development and contribute to a positive team culture. Stay current on industry best practices and incorporate them into the claims strategy and payment integrity processes. Represent the company in meetings and presentations related to claims processing and payment integrity. Ensure compliance with all privacy and security regulations related to claims data. Continuously assess and improve processes and procedures to enhance efficiency and effectiveness. Perform other duties as assigned by senior management.

Cigna is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

Apply Job!