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

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

• 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 information, diagnosis codes, dates, services, procedure codes, and charges • 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 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 with benefit negotiations • Provide backup support to other examiners • Support claim appeals and disputes with documentation • Research, calculate, and request refunds • Complete renewal reports and process eligible claims before stoploss contract renewal periods end • Assist with subrogation claims, group meetings, audits, and plan benefit setup or changes • Maintain regular and punctual attendance and contribute to daily workflow

🎯 Requirements

• High school graduation or GED required • Basic computer and customer service experience required • Excellent oral and written communication skills • PC skills, including Windows and Word • Ability to learn and use claims processing software and adapt to software changes • Typing ability of 45 wpm net • Excellent listening skills • Basic mathematical skills • Ability to organize and recall detailed information • Ability to read, analyze, and 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 comply with privacy and confidentiality standards • Ability to work flexibly under pressure and meet deadlines • Ability to analyze and solve problems, exercise good judgment, and make decisions professionally • Ability to operate typical office equipment • Working knowledge of general office procedures

🏖️ Benefits

• Remote work arrangement • Work-from-home internet connection requirement: cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload • Tobacco-free policy and smoking cessation program opportunity where applicable