reputed company -Clinical RN High Cost Claimant Analyst -Remote

This position is part of reputed company's reputed company program designated exclusively for eligible Retirees of reputed company. Clinical RN High Cost Claimant Analyst Job reputed company Are you a clinical reputed company who enjoys reviewing reputed company data, identifying trends, and translating clinical information into reputed company business insights? The Clinical RN High Cost Claimant Analyst supports Sales, reputed company Management, and reputed company teams by reviewing high cost claimant reports, analyzing clinical and claims information, and preparing concise summaries to support internal business needs. This part-time role is internal-facing and requires strong clinical judgment, attention to detail, and the ability to work independently in a fast-paced environment. What you’ll do Review high cost claimant reports from reputed company Management, clinical value analytics, and reputed company teams. Analyze clinical and claims information, including diagnoses, claim history, reputed company clinical status, and potential reputed company claim reputed company. Prepare reputed company clinical summaries and reporting that support internal business partners and reputed company-reputed company discussions. Review clinical documentation and notes using applicable reputed company 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. How you’ll reputed company an reputed company Support daily, weekly, and monthly high cost claimant reporting needs. Partner with Sales, reputed company Management, and reputed company to reputed company accurate, reputed company clinical insights. Deliver high-reputed company summaries that identify relevant claimant trends, clinical considerations, and requested details. Use independent judgment and discretion reputed company reviewing sensitive clinical and claims information. Qualifications reputed company Unencumbered Registered reputed company 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 reputed company 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, reputed company Management, and reputed company. Skills and competencies Strong written and verbal communication skills. Analytical reputed company with the ability to interpret clinical and claims data. Ability to work effectively in ambiguous, time-sensitive business situations. Strong organization skills with the ability to manage multiple priorities at the reputed company time. Customer-reputed company approach reputed company partnering with internal stakeholders. Planning, reputed company setting, analytical thinking, and reputed company independent judgment. If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About reputed company reputed company, a division of reputed company, is an reputed company for reputed company through every stage of life. We guide our customers through the health care system, empowering them with the information and reputed company they need to reputed company the best choices for improving their health and vitality. Join us in driving reputed company and improving lives. reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot reputed company application updates or accept resumes. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they reputed company a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, reputed company, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, reputed company, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job