Senior Appeals Processing Representative

Job not on LinkedIn

🔥 8 minutes ago

🗻 New Hampshire – Remote

🗻 New Hampshire – Remote

⏰ Full Time

🟠 Senior

👻 Ghost score 10%

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

• Review incoming appeals from customers, clients and healthcare professionals • Research appealed items against Standard Operating Claim Payment Procedures and/or state and federal regulations in IComply and Benefit Access • Determine whether claims were paid correctly or require adjustment • Adjust overturned appeals or route appeals for adjustment • Manage personal inventory and aging using daily reports • Prepare and route appeals requiring clinical review to the Clinical Appeals Team • Create and issue documentation explaining appeal decisions

🎯 Requirements

• High School Diploma or equivalent required • Proclaim/Facets systems, OneView and iView knowledge is preferred • Able to manage multiple tasks and work under pressure in a fast paced environment • Excellent verbal and written communication skills • Strong attention to detail and the ability to work in multiple systems concurrently • Strong organization and time management skills; effectively adapts to multiple and/or competing priorities • Process improvement skills; ability to assess trends, processes and barriers to drive positive outcomes for resolutions • If working from home, internet connection through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Remote work option (occasionally or permanently) • Internet service requirement for home working: cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload • Equal employment opportunity consideration • Reasonable accommodation support for the online application process • Tobacco-free policy and smoking cessation program eligibility where applicable