Senior Appeals Processing Representative

Job not on LinkedIn

🔥 0 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

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 incoming Appeals from Customers, Clients and HealthCare Professionals • Research item being appealed against Standard Operating Claim Payment Procedures and/or State and Federal Regulations in IComply, and Benefit Access • Determine if the claim issue in question was paid correctly or needs an adjustment • Adjust overturned appeals or appropriately route the appeal for adjustment • Manage personal inventory and aging by use of daily reports provided • Prepare and route appeals requiring clinical review to the Clinical Appeals Team • Create and issue documentation explaining appeal decision

🎯 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 • Internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload for employees working at home • Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances

🏖️ Benefits

• Remote work arrangement • Cable broadband or fiber optic internet requirement for work-from-home employees