Clinical RN High Cost Claimant Analyst

The Cigna Group

Clinical RN High Cost Claimant Analyst analyzing high cost claimant reports to support internal teams at Cigna's Encore program. Requires active RN license and CCM certification or BSN preference.

Posted 6/18/2026part-timeRemote • New York • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

Flexible work arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

case managementclaims analysisclinical documentation reviewclinical value analyticsdiagnosis analysisclaims history reviewreport preparationhigh cost claims review

Soft Skills

independent worktime managementcommunicationcollaboration

Certifications

Registered Nurse licenseCertified Case Manager (CCM)Bachelor of Science in Nursing (BSN)