Claims Representative - Remote

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Our people make all the difference in our success.
Claims Representatives
Help our customers maintain their health, well-being and sense of security by ensuring medical claims are processed accurately and timely for healthcare providers and policy holders 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

• Partner with Technical Coaches to understand claim processes and procedures.
• 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.
• 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.
• Follow processes and work independently to meet or exceed Key Performance Indicators (KPI)
• Maintains a high level of accuracy in all duties performed.
• Partner with the Resource Management Group (RMG) on Workflow Tool (WFT), pended claims, or other inventory issues.
• Adapt to and positively influence change by accepting feedback with a growth mindset to continuously improve.
• Follows established policies and procedures to pay, pend for additional information, or deny claims.
• Review claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.

Experience Required:

• High level of computer navigational skills with experience using shortcut keys
• Proficient in Microsoft Office applications, Word, Excel, Outlook, OneNote, and Power Point
• Excellent organizational, interpersonal, written and verbal communication skills
• Knowledge of medical and insurance industry terminology required
• Medical coding knowledge preferred
• Experience in delivering exceptional customer service
• Must possess strong attention to detail and problem-solving skills with a high level of accuracy
• Must be able to type and use a keyboard for extended periods of time
• Integrity and personal accountability for job performance and expectations
• Ability to perform comfortably in a fast-paced, deadline-oriented work environment
• Proven ability to learn a variety of benefit plans

** This position will start on 6/5/23
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 - 24 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: [email protected] for support. Do not email [email protected] 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.