Provider Relations Manager - Cigna Healthcare - Remote - KS, MO

Candidates who reside within 50 miles of the following locations may be asked to work in person three days per week: Overland Park, KS or St. Louis, MO.

In order to support the business and due to the assigned Book of Business, we are planning to hire a candidate from Kansas or Missouri.

SUMMARY 

The Provider Relations Manager / Provider Relations Lead Analyst, is an external provider facing role with account management responsibilities for a medium to low complex book of business. The role is accountable for the overall provider experience by working in collaboration with matrix partners to drive on-going service improvements, understand, articulate and resolve service impacts, and drive the overall provider strategic planning solutions. This individual is empowered within their scope to make decisions as it pertains to the experience with Cigna, is required to have local market knowledge and visibility, builds and continuously improve the relationship between Cigna and the provider. 

DUTIES AND RESPONSIBILITIES 

• Accountable for the end-to-end provider experience and overall service delivery for assigned Book of Business aligned to medium to low complex providers 

• Leads, collaborates, and supports local market direction as it relates to improving the provider experience 

• Creates and maintains individual provider strategic action plans 

• Proactively identify new opportunities and risks for providers at market or national level and drives resolution 

• Exercises good judgment and discretion to support the provider experience 

• Responsible for capturing, documenting, and sharing market intelligence; use market intelligence to develop and drive strategic improvements 

• External facing with providers in assigned BOB  

• Collect, analyze, interpret, translate and distribute provider informatics, reports, dashboards 

• Track and monitor performance guarantees for assigned BOB 

• Promotes Provider Index score improvement through proactive and effective service and support of network 

• Review provider reports/dashboard with individual providers  

• Proactively educate providers on Cigna's business objectives, standard operating procedures, policies and programs to influence behavior and how to work with Cigna 

• Serve as a provider advocate both internally and externally 

• Understands and applies service culture principles and methodology 

• Serves as a provider advocate both internally and externally 

• Serves in a consultative role or subject matter expert to key matrix partners 

• Develops and participates in presentations to existing and prospective providers and/or clients 

• Serves as advocate in external community, representing CIGNA to medical societies and external provider associations. 

• Manage joint operating committees, including agenda development, facilitating appropriate meeting participation and follow up activities 

PREFERRED QUALIFICATIONS  

• Bachelor's degree or higher strongly preferred or equivalent work experience required.

• 5+ years of experience in provider relations highly preferred.

• Claims administration experience is highly preferred.

• Solid root cause analysis with claims issues is highly preferred.

• Experience with MS Office (Word, Outlook, PowerPoint) is highly preferred.

• Solid experience with Excel (to include pivot tables and VLOOKUP) is highly preferred. 

• Knowledge of other systems include Proclaim, Facets and PWB would be preferred.

• Understanding of medical insurance products and associated provider issues is highly preferred.

• Ability to lead cross-functional partners to a common goal.

• Demonstrated excellent oral, written, interpersonal, analytical, and negotiation skills. 

• Ability to work in a matrix environment. 

• Travel may be required (up to 25%)

CORE COMPETENCIES 

• Organizational savvy, Plans and aligns,  Collaborates, Communicates Effectively, Interpersonal Savvy, Tech Savvy, Being Resilient, Action oriented, Decision quality, Customer Focus, Builds Networks, Instills Trust