Provider Data Lead Representative - Evernorth - Remote

Cigna Healthcare•New Hampshire Work at Home, NH

1d•$24 - $36•Remote

About The Position

The Provider Data Lead Representative is responsible for accurately maintaining, correcting, and preserving provider data integrity to support network quality. The role manages provider information across core systems, including HCPM, CPF, and Facets, through timely additions, updates, corrections, and terminations. It also resolves claim, demographic, and contract-related fallout to prevent recurrence and improve data accuracy and the customer and provider experience. The position analyzes partner requests, applies contract terms and network business rules, validates data across systems and downstream platforms, and investigates operational issues through root cause analysis. The representative maintains production and quality standards, documents work in the Daily Activity Log, and supports system enhancements through testing and validation. The position is remote. For work performed at home, a cable broadband or fiber optic internet connection with speeds of at least 10 Mbps download and 5 Mbps upload is required. The anticipated hourly rate is $24–$36, depending on relevant factors such as experience and geographic location. The role is anticipated to be eligible for an annual bonus plan.

Requirements

High school diploma or GED.
At least 2 years of demonstrated proficiency using CPF and HCPM.
Strong understanding of data flow and downstream system impacts.
Knowledge of provider structures, including Practitioners, Groups, Facilities, and Ancillaries.

Nice To Haves

Some college coursework.
Proficiency with Proclaim and Facets.
Solid understanding of contracts, networks, and applicable Market Guidebook standards.
Working knowledge of DAL, Inventory Manager, ETQS, Activity Manager, Provider Manager, Renaissance, and Knowledge Exchange.

Responsibilities

Execute provider data additions, terminations, and updates in accordance with established procedures and business needs.
Perform data remediation in HCPM, CPF, and Facets to maintain system accuracy and consistency.
Implement updates identified through quality audits and performance analyses to improve data integrity.
Apply contract terms and network business rules to ensure accurate and compliant data outcomes.
Identify operational risks and issues during data load processes and take appropriate corrective action.
Validate data accuracy across multiple systems and ensure successful transmission to downstream platforms.
Conduct root cause analysis to diagnose issues and implement solutions aligned with desired outcomes.
Analyze intake requests from matrix partners, assess their impact, and execute appropriate provider, network, or criteria-level updates across systems.
Meet production and quality standards, including accurate and timely documentation in the Daily Activity Log (DAL).
Support system enhancement initiatives by participating in testing, validation, and checkout activities as directed.
Collaborate within a team while remaining accountable for individual contributions and results.