Claims Representative- Remote

• SUMMARY
• Delivers straightforward administrative and/or other basic business services in Claims. Examines and processes paper claims and/or electronic claims. Determines whether to return, pend, deny or pay claims within policies. Determines steps necessary for adjudication. Settles claims with claimants in accordance with policy provisions. Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim. Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries. Issues tend to be routine in nature. Good knowledge and understanding of Claims and business/operating processes and procedures. Works to clearly defined procedures under close supervision.
• Claims Representatives

• Help our customers maintain their health, well-being and sense of security by ensuring medical claims are processed accurately and timely while protecting the confidentiality of our customer’s personal health information. Under direct supervision performs duties relating to the claims adjudication process from review of the claim form, verification of eligibility, verification of coordination of benefits with insurance carriers, and finalizing based on the health benefits plan. Technical advice and assistance will be provided by Technical Coaches.

  Responsibilities

  • Review claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.

  • Follows established policies and procedures to pay, pend for additional information, or deny claims.

  • Adapt to and positively influence change by accepting feedback with a growth mindset to continuously improve.

  • Follow processes and work independently to meet or exceed Key Performance Indicators (KPI)

  • Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1x1 or check-ins, using a variety of virtual tools, i.e. Outlook email, Skype for Business, Cisco Web-Ex or other similar applications.

  • Maintains a high level of accuracy in all duties performed.

  • Team members will be held accountable for meeting and maintaining minimum quality and production standards through use of Management Operating Systems (MOS) tools: Daily Production Log (DPL), Performance Profile, Claim Review tool, and other reporting systems.

  • Partner with the Resource Management Group (RMG) on Workflow Tool (WFT), pended claims, or other inventory issues.

  • Partner with Technical Coaches to understand claim processes and procedures.

  Experience Required:

  • Must possess strong attention to detail and problem-solving skills with a high level of accuracy

  • High level of computer navigational skills with experience using shortcut keys

  • Proficient in Microsoft Office applications, Word, Excel, Outlook, OneNote, and Power Point

  • Knowledge of medical and insurance industry terminology including CPT/ICD-10 codes

  • Excellent organizational, interpersonal, written and verbal communication skills

  • Experience in delivering exceptional customer service

  • Ability to perform comfortably in a fast-paced, deadline-oriented work environment

  • Must be able to type and use a keyboard for extended periods of time

  • Integrity and personal accountability for job performance and expectations

  • Proven ability to learn a variety of benefit plans

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 17 - 26 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.