Health Claims Examiner

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🔥 0 minutes ago

🦬 Montana – Remote

🦬 Montana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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

• Process medical, dental, vision, and prescription drug claims accurately and timely • Verify required claim documentation • Collaborate with providers, plan participants, other payers, and relevant parties to obtain claim information • Analyze participant, provider, diagnosis, service, procedure, and charge information • Ensure claims are processed correctly and payments are determined according to the plan • Prepare correspondence regarding pre-determinations and basic benefit questions • Answer participant, group contact, and customer service representative calls about benefits and claims • Resolve problematic claims with support from claims leadership • Assign critically ill patients to large case management and assist case managers • Provide backup support to other examiners • Support claim appeals and disputes with documentation • Research, calculate, and request refunds • Maintain regular and punctual attendance and contribute to daily workflow • Complete renewal reports and process eligible claims before stoploss contract renewal periods end • Assist with subrogation claims, group meetings, audits, and plan benefit setup and changes

🎯 Requirements

• High school graduation or GED required • Basic computer experience required • Customer service experience required • Excellent oral and written communication skills • PC skills, including Windows and Word • Ability to learn and adapt to claims processing software changes • Typing ability of 45 wpm net • Excellent listening skills • Basic mathematical skills • Strong interpersonal skills to work effectively with others • Ability to organize and recall detailed information • Ability to interpret benefit plans, insurance documents, regulations, and apply them to specific situations • Ability to meet productivity standards with 99% financial accuracy and 95% procedural accuracy • Thorough knowledge of claims processing procedures and requirements • Ability to maintain privacy and confidentiality • Flexibility to work under pressure and meet deadlines • Problem-solving ability and good judgment • Ability to operate typical office equipment • Working knowledge of general office procedures • Home internet through cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload if working from home

🏖️ Benefits

• Remote work may be occasional or permanent • Cable broadband or fiber optic internet service with at least 10 Mbps download/5 Mbps upload required for home working • Reasonable accommodation available for the online application process