Claims Representative

🔥 8 minutes ago

🇺🇸 United States – Remote

💵 $17 - $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.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.

Apply Now

Find Similar Remote Jobs

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

• Review medical records, authorization documentation, and claim information to support post-service medical necessity reviews • Verify member eligibility, benefits, coverage, authorizations, and claim requirements • Build and maintain authorization cases and attach clinical documentation for review by clinical staff • Process Radiology, Pain Management, Lab, Gastro, and other designated claims according to established policies and procedures • Adjudicate claims and process claim adjustments based on authorization and clinical review outcomes • Research and resolve claim discrepancies, missing information, and pending claim inventories • Create and manage ECRM tickets and other operational workflows supporting claim resolution • Ensure compliance with client requirements, benefit plans, policies, and regulatory guidelines • Meet established productivity, quality, and service performance expectations • Review and process Post Service Medical Necessity Determination claims; the role does not make medical necessity determinations or authorization approval or denial decisions

🎯 Requirements

• High School Diploma or equivalent required • Medical terminology knowledge • CPT and ICD-10 coding knowledge • Health insurance claims processing experience • Ability to interpret benefit plans and policy language • Proficiency with Microsoft Office Suite • Ability to navigate multiple applications simultaneously • Comfortable working in a virtual environment using Teams, Outlook, Cisco WebEx, and similar tools • Strong attention to detail and accuracy • Ability to identify discrepancies and missing information • Self-motivated and accountable • Strong time management • Adaptability and growth mindset • Effective written and verbal communication • Ability to meet productivity and quality KPIs • Customer-focused service delivery • Working knowledge of medical claims processing, provider issue resolution, and healthcare operational workflows preferred • Experience utilizing MC400, ICE, NASCO, ImageOne, Outlook, Microsoft Excel, and Microsoft Word a nice to have • Knowledge of medical terminology and CPT/ICD-10 coding preferred • Proven ability to work collaboratively across operational, provider, program, and client-facing teams • Demonstrated ability to manage multiple priorities while maintaining quality and productivity standards • If working from home, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload required

🏖️ 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 • Remote work arrangement

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume