Cigna Healthcare is hiring a Plan Automation Senior Representative to build, maintain, and support medical, dental, and vision benefit plans within our claims processing system. This position plays a critical role in ensuring accurate plan configuration and updates to enable smooth claims processing and successful new group implementations.
What You'll Do
- 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 and benefit summaries, translating 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.
What We're Looking For
- High School Diploma or GED required.
- 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.
Nice to Have
- 2+ years experience with medical claims, processing & benefits.
- Training in medical terminology & health benefits.
- Experience with claims processing systems and reporting tools.
- Experience with VBA software.
Technical Stack
- Claims processing systems
- Reporting tools
- VBA software
Work Mode
This is a remote position.
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.
