Claims Representative

🔥 0 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Accurately and timely process Supplemental Health claims • Review claim submissions and confirm required documentation • Verify medical codes, eligibility, coverage, other insurance, authorizations, and 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 • Meet or exceed established quality, productivity, performance, and KPI standards • Participate in virtual team huddles, supervisor one-on-ones, and check-ins using Outlook, Microsoft Teams, Cisco Webex, and similar tools • Maintain accuracy, confidentiality, and regulatory compliance • Use multiple computer applications simultaneously • Identify discrepancies, errors, and missing information • Maintain production and quality standards using eMOS tools, including DPL, Performance Profile, Ring Master, SAM3, and other reporting systems • Partner with the Resource Management Group on Workflow Tool, COGNOS pending reports, and inventory issues • Work with supervisors, coaches, and trainers to improve claim processing techniques and workflows • Work independently in a virtual environment with accountability, professionalism, and time management

🎯 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 • Strong organizational skills and ability to prioritize tasks to meet 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 of time • 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 service with speeds of at least 10Mbps download/5Mbps upload for home working

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • 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 • Structured training program with virtual classroom instruction and on-the-job coaching • Remote work from home • Cable broadband or fiber optic internet service requirement with at least 10Mbps download/5Mbps upload