[Remote] Encore -Clinical RN High Cost Claimant Analyst -Remote

Note: The job is a remote job and is open to candidates in USA. The Cigna Group is dedicated to advocating for better health through every stage of life. They are seeking a Clinical RN High Cost Claimant Analyst to support Sales, Client Management, and Underwriting teams by reviewing high cost claimant reports and analyzing clinical data to provide business insights.ResponsibilitiesReview high cost claimant reports from Client Management, clinical value analytics, and Underwriting teamsAnalyze clinical and claims information, including diagnoses, claim history, current clinical status, and potential future claim impactPrepare clear clinical summaries and reporting that support internal business partners and client-related discussionsReview clinical documentation and notes using applicable Cigna and CGHB clinical documentation and reporting systemsParticipate in meetings and conference calls to discuss high cost claimant reports, trends, and requested follow-up informationSupport daily, weekly, and monthly high cost claimant reporting needsPartner with Sales, Client Management, and Underwriting to provide accurate, timely clinical insightsDeliver high-quality summaries that identify relevant claimant trends, clinical considerations, and requested detailsUse independent judgment and discretion when reviewing sensitive clinical and claims informationSkillsActive Unencumbered Registered Nurse license in state of residenceCase management experience and claims payer experienceExperience reviewing high cost claims, clinical documentation, and claims historyAbility to use clinical documentation and reporting systems, including Cigna and CGHB systemsDemonstrated ability to work independently, manage variable workloads, and meet time-sensitive deadlinesExperience communicating with clinical and non-clinical partners, including Sales, Client Management, and UnderwritingStrong written and verbal communication skillsAnalytical mindset with the ability to interpret clinical and claims dataAbility to work effectively in ambiguous, time-sensitive business situationsStrong organization skills with the ability to manage multiple priorities at the same timeCustomer-focused approach when partnering with internal stakeholdersPlanning, priority setting, analytical thinking, and sound independent judgmentCertified Case Manager (CCM) certification or Bachelor of Science in Nursing (BSN) strongly preferredCompany OverviewThe Cigna Group is a healthcare firm that focuses on providing hospital services and innovative solutions for better health. It was founded in 1981, and is headquartered in Bloomfield, Connecticut, USA, with a workforce of 10001+ employees. Its website is https://www.cigna.com/.