[Remote] Encore -Clinical RN High Cost Claimant Analyst -Remote

Note: The job is a remote job and is open to candidates in USA. The Cigna Group is dedicated to advocating for better health through every stage of life. They are seeking a Clinical RN High Cost Claimant Analyst to support Sales, Client Management, and Underwriting teams by reviewing high cost claimant reports and analyzing clinical data to provide business insights.

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
• Support daily, weekly, and monthly high cost claimant reporting needs
• Partner with Sales, Client Management, and Underwriting to provide accurate, timely clinical insights
• Deliver high-quality summaries that identify relevant claimant trends, clinical considerations, and requested details
• Use independent judgment and discretion when reviewing sensitive clinical and claims information

Skills

• Active Unencumbered Registered Nurse license in state of residence
• 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
• Strong written and verbal communication skills
• Analytical mindset 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 same time
• Customer-focused approach when partnering with internal stakeholders
• Planning, priority setting, analytical thinking, and sound independent judgment
• Certified Case Manager (CCM) certification or Bachelor of Science in Nursing (BSN) strongly preferred

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