Claims Representative

🔥 2 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

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

• Review medical records, authorization documentation, and claim information for post-service medical necessity reviews • Verify member eligibility, benefits, coverage, authorizations, and claim requirements • Build and maintain authorization cases • Obtain 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 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 without making medical necessity determinations or authorization approval/denial decisions

🎯 Requirements

• High School Diploma or equivalent required • 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 nice to have • Knowledge of medical terminology and CPT/ICD-10 coding preferred • Medical terminology knowledge • CPT and ICD-10 coding knowledge • Health insurance claims processing experience • Ability to interpret benefit plans and policy language • Strong attention to detail and accuracy • Ability to identify discrepancies and missing information • Proficient with Microsoft Office Suite • Ability to navigate multiple applications simultaneously • Comfortable working in a virtual environment using Teams, Outlook, Cisco WebEx, and similar tools • 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 • 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 • For home working, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload

🏖️ 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 • Remote work/home-based arrangement • Cable broadband or fiber optic internet requirement for home working

📊 Check your resume score for this job

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

Upload Resume