Claims Representative

🔥 5 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $17 - $26 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Manually review and process medical, supplemental, or dental claims • Process claims according to benefits, eligibility, and internal processes, policies, and procedures • Complete, hold for additional information or review, or deny claims as appropriate • Research and navigate documents and databases to process claims accurately and compliantly • Confirm necessary documents are present in submitted claims • Validate medical codes in claim submissions • Assess claim eligibility • Review and verify other insurance coverage information • Evaluate authorizations for accuracy • Analyze account benefit plans to ensure claims align with coverage and policies • Identify discrepancies, errors, and missing information • Use multiple computer applications simultaneously • Meet or exceed quality and productivity goals • Work with supervisors, coaches, and trainers to improve processing techniques and workflows • Use Outlook, Cisco Webex, and similar virtual tools to collaborate and communicate with colleagues and supervisors • Complete a robust training program and meet accuracy, quality, volume, claims-per-hour, and production metrics after training

🎯 Requirements

• High school diploma or equivalent • Ability to quickly learn a variety of computer applications • Experience sending and receiving emails, scheduling calendar appointments and sending invitations, and attaching files in Microsoft Outlook • Knowledge of basic Microsoft Excel functions, such as filtering and sorting • Experience navigating multiple computer applications using shortcut keys and other techniques • Detail-oriented with experience applying complex policy and procedure documents • Strong organizational skills and ability to prioritize tasks before deadlines • Proven experience completing work to quality and productivity performance standards • Experience working independently in a virtual environment preferred • Experience with medical and insurance terminology in a professional setting preferred • Knowledge of CPT/ICD-10 codes preferred • Proven experience in health insurance claims processing or a similar field preferred • Cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload when working from home

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Robust training program including virtual classroom training, on-the-job learning, and feedback