Encore -Clinical RN High Cost Claimant Analyst -Remote

This position is part of Cigna's Encore program designated exclusively for eligible Retirees of Cigna.

Clinical RN High Cost Claimant Analyst

Job Description

Are you a clinical professional who enjoys reviewing complex data, identifying trends, and translating clinical information into clear business insights? The Clinical RN High Cost Claimant Analyst supports Sales, Client Management, and Underwriting teams by reviewing high cost claimant reports, analyzing clinical and claims information, and preparing concise summaries to support internal business needs. This part-time role is internal-facing and requires strong clinical judgment, attention to detail, and the ability to work independently in a fast-paced environment.

What you’ll do

• Review high cost claimant reports from Client Management, clinical value analytics, and Underwriting teams.
• Analyze clinical and claims information, including diagnoses, claim history, current clinical status, and potential future claim impact.
• Prepare clear clinical summaries and reporting that support internal business partners and client-related discussions.
• Review clinical documentation and notes using applicable Cigna and CGHB clinical documentation and reporting systems.
• Participate in meetings and conference calls to discuss high cost claimant reports, trends, and requested follow-up information.

How you’ll make an impact

• Support daily, weekly, and monthly high cost claimant reporting needs.
• Partner with Sales, Client Management, and Underwriting to provide accurate, timely clinical insights.
• Deliver high-quality summaries that identify relevant claimant trends, clinical considerations, and requested details.
• Use independent judgment and discretion when reviewing sensitive clinical and claims information.

Qualifications

• Active Unencumbered Registered Nurse license in state of residence.
• Certified Case Manager (CCM) certification or Bachelor of Science in Nursing (BSN) strongly preferred.
• Case management experience and claims payer experience.
• Experience reviewing high cost claims, clinical documentation, and claims history.
• Ability to use clinical documentation and reporting systems, including Cigna and CGHB systems.
• Demonstrated ability to work independently, manage variable workloads, and meet time-sensitive deadlines.
• Experience communicating with clinical and non-clinical partners, including Sales, Client Management, and Underwriting.

Skills and competencies

• Strong written and verbal communication skills.
• Analytical mindset with the ability to interpret clinical and claims data.
• Ability to work effectively in ambiguous, time-sensitive business situations.
• Strong organization skills with the ability to manage multiple priorities at the same time.
• Customer-focused approach when partnering with internal stakeholders.
• Planning, priority setting, analytical thinking, and sound independent judgment.

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 need a reasonable accommodation to complete the online application process, please email [email protected] for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.