Non-Par Provider Contracting Advisor - Cigna Healthcare - Remote

The Cigna Group

1d • Remote

About The Position

The job profile for this position is Provider Contracting Advisor, which is a Band 4 Senior Contributor Career Track Role.
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Provides subject-matter expertise for Cigna’s Out-of-Network (OON) Protection Programs, including the Network Savings Program (NSP) and Bill Negotiation Services (BNS). Serves as a shared service supporting all Cigna platforms in achieving OON goals.
Oversees program administration across multiple claim systems and acts as the primary expert on NSP and BNS, including the impact of federal and state surprise billing laws on claim workflows. Ensures vendor compliance, advises leaders and matrix partners, and provides thought leadership within the Out-of-Network Protection Team while supporting broader cross-functional initiatives.

Requirements

• Bachelor’s degree preferred
• Minimum 10 years of industry experience
• Strong knowledge of claims engines and out-of-network / non-PAR programs
• PMHS claim engine experience required; ProClaim and Facets preferred
• Data analysis experience using tools such as TOAD, SAS, or SQL preferred
• Strong communication skills with the ability to translate complex concepts for non-technical audiences
• Healthcare industry experience required; OON expertise strongly preferred
• Proven analytical, technical, and business acumen
• Ability to work independently and collaboratively in matrixed environments
• Demonstrated ability to drive change and improve process efficiency
• 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.

Responsibilities

• Track and trend PMHS program performance; partner with Service Operations to resolve pricing, finalization, and adjustment issues
• Coordinate resolution of aged and outstanding vendor claims
• Support development and maintenance of Reason, Remark, and Explanation codes across all claim engines; maintain active and sunset code lists
• Develop and maintain vendor reconciliation processes to ensure accurate claim processing and fee billing
• Manage vendor fee reimbursement processes, including configuration, changes, and exceptions
• Partner with ONPT teams to identify and implement process and system improvements
• Develop and maintain procedural documentation in collaboration with Service Operations, Compliance, Legal, and claim engine teams
• Lead quarterly SOX audit reviews and responses to demonstrate control adherence

Benefits

• At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
• For more details on our employee benefits programs, click here.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level