Plan Automation Senior Representative - Cigna Healthcare - Remote
Job Summary This role is responsible for building, maintaining, and supporting medical, dental, and vision benefit plans within the claims processing system. The position ensures accurate plan configuration, updates, and support to enable smooth claims processing and successful new group implementations.
Key Responsibilities
Lead the configuration, maintenance, and optimization of medical, dental, and vision benefit plans within claims processing systems. Design, build, and maintain deductibles, coinsurance, out‑of‑pocket maximums, benefit codes, and plan details aligned to approved plan documents. Configure benefit logic based on provider type, specialty, place of service, procedures, and diagnoses to ensure accurate claims adjudication. Interpret complex plan documents, benefit summaries, and translate them into system configuration and coding. Maintain benefit definitions, benefit levels, plan maximums, exception codes, and benefit reporting with a high degree of accuracy. Partner with claims, health services, and operational teams to support new group implementations and resolve plan or benefit configuration issues. Review plan amendments and lead timely system updates to ensure compliance and operational readiness. Analyze claims processing issues, identify root causes, and recommend efficient solutions. Run and interpret reports and data searches to support audits, issue resolution, and ongoing plan maintenance. Demonstrate deep understanding of claims processing workflows. Apply strong analytical, problem‑solving, and decision‑making skills in a fast‑paced environment. Leverage medical terminology, health insurance concepts, and basic mathematical principles to support accurate benefit configuration. Ability to learn and apply system‑specific coding or configuration logic required to support claims processing platforms. Exhibit strong organizational skills with the ability to manage multiple plan components, priorities, and deadlines simultaneously. Communicate effectively and collaborate with cross‑functional while maintaining a professional demeanor. Maintain strict adherence to confidentiality, privacy, and data protection standards. Demonstrate flexibility, accountability, and professionalism while working under pressure.
Requirements
High School Diploma or GED required. 2+ years’ experience with medical claims, processing & benefits is preferred. Ability to read, interpret, and apply plan documents accurately. Strong attention to detail and ability to manage multiple plan components. Strong problem‑solving and analytical skills. Ability to collaborate effectively with cross‑functional teams. Training in medical terminology & health benefits is preferred. Experience with claims processing systems and reporting tools is preferred. Experience with VBA software is preferred. About Allegiance by Cigna Healthcare Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation’s most innovative health benefit strategies. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Cigna Healthcare 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. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group 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 enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Apply tot his job Apply To this Job