Claims Representative

🔥 15 minutes ago

🇺🇸 United States – Remote

💵 $17 - $26 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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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

• Accurately and timely process Supplemental Health claims • Review claim submissions and confirm required documentation • Verify medical codes, eligibility, other insurance, authorizations, and account benefit plans • Interpret policy provisions and determine benefit eligibility • Pay, pend for additional information, or deny claims according to established policies and procedures • Manage pending claims and issue claim decisions • Participate in virtual team huddles, supervisor one-to-ones, and check-ins using virtual tools • Meet or exceed established quality, productivity, KPI, and performance standards • Identify discrepancies, errors, and missing information • Use eMOS tools and reporting systems, including DPL, Performance Profile, Ring Master, SAM3, and other systems • Partner with the Resource Management Group on WFT, COGNOS pend report claims, and inventory issues • Work with supervisors, coaches, and trainers to improve claim-processing techniques and workflows • Maintain confidentiality and compliance with company policies and regulatory requirements

🎯 Requirements

• High School diploma or equivalent • Strong attention to detail and problem-solving skills with a high level of accuracy • Ability to navigate multiple computer applications using shortcut keys and other techniques • Proficiency in Microsoft Office applications, including Word, Excel, Outlook, OneNote, and PowerPoint • Knowledge of medical and insurance industry terminology, including CPT/ICD-10 codes • Proven experience in health insurance claims processing or a similar field preferred • Excellent organizational, interpersonal, written, and verbal communication skills • Ability to prioritize tasks and complete work before deadlines • Experience delivering exceptional customer service • Ability to perform comfortably in a fast-paced, deadline-oriented work environment • Ability to type and use a keyboard for extended periods • Integrity and personal accountability for job performance and expectations • Ability to interpret policy language and apply complex benefit provisions • Cable broadband or fiber optic internet connection with at least 10 Mbps download and 5 Mbps upload for home-based work

🏖️ 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 • Virtual classroom instruction and on-the-job coaching during training