Claims Representative Job Description

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We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

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

• 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

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make?  To see our culture in action, search #TeamCigna on Instagram.

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.