Job Description

Subrogation Senior Analyst

The job profile for this position is Quality Review and Audit Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.

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Role Summary:

As Quality Review and Audit Senior Analyst within Payment Integrity FWA Team you will be directly supporting Cigna\xe2\x80\x99s affordability commitment within Cigna International\'s business. This role is responsible for the development of processes to identify, investigate and seek recoveries for subrogation cases across Cigna\xe2\x80\x99s Global claims platforms. This includes establishing and operating internal inter team processes to direct inbound requests for subrogation against Cigna and the development of data analytics to proactively identify where subrogation rights might be applied for countries not already covered by existing outsource capabilities. He/ She will work closely with Medical Economics, Data Analytics, Claims Operations, Clinical partners, Legal and Compliance, Account Management.

Responsibilities:

• Responsible for documenting and maintaining standard operating protocols (SOPs) related to subrogation.
• Serve as subject matter expert on all aspects of process and platform usage bespoke to subrogation.
• Develop workflow and capability for recording subrogation cases on case management system.
• Develop operational dashboards to support the assessment of work demand against capacity to ensure optimum pipeline across all referral routes; create solutions, drive execution and ensure timeliness and accuracy of processes, loss negotiations and recovery activity.
• Ensure financial recoveries and prevention activities are being tracked and reported accurately.
• Review clams and supporting documents to identify third party liability that caused injuries to Cigna insured.
• Interview customer, provider and/ or third-parties to establish liability and opportunity.
• Seek recovery of payments from third-parties responsible for the health damages caused to the insured or third-party insurer.
• Negotiate settlement agreements.
• Partner with Customer Services and Account Management on educating customers and clients regarding the subrogation rights and obtaining required documentation.
• Ensure cases are tracked and reported accurately.
• Perform data-mining to reveal trends and patterns of subrogation cases.
• Recommend changes in policy and procedures in order to mitigate risk and participates in projects to improve business protocols.
• Partner with Cigna TPAs on subrogation cases.
• Partner with Payment Integrity and other teams to raise awareness of schemes that fall under subrogation scope.
• Partner with Data Analytics team in building triggers to automate subrogation detection.
• Provide ongoing operational analysis of process components, while identifying and implementing changes as necessary to improve the level of quality and efficiency as measured by key performance indicators.
• Provide reports to internal and external stakeholders on prevention and recovery metrics.
• Working closely with other departments to ensure Payment Integrity activities do not have an unnecessary negative impact on our customers.

Skills and Requirements:

• You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best.
• Minimum of 4 years of experience in subrogation within health insurance sector.
• Experience and confidence in liaising with internal and external stakeholders.
• Commercial experience operating effectively under pressure and delivering results.
• Knowledge of Mainframe, Diamond, Actisure and/or Globalcare is preferred.
• Ability to negotiate settlement agreements and experience in litigation processes.
• Knowledge of claims coding, regulatory rules and medical policy.
• Medical/ paramedical qualification is a definite plus.
• Critical mind-set with ability to understand regulatory and legal context.
• Experience with data analytics.
• Demonstrated strong organization skills.
• Strong attention to detail.
• Ability to quickly learn new and complex tasks and concepts.
• Excellent verbal and written communication skills.
• Ability to balance multiple priorities at once and deliver on tight timelines.
• Flexibility to work with global teams and varying time zones effectively.
• Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines.
• Dedicated to meeting the expectations and requirements of internal and external customers, excellent at building effective relationships and gaining trust and respect.
• Fluency in foreign languages in addition to fluent English is a strong plus.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Cigna