Job Description

Claims Representative \xe2\x80\x93 RemoteSUMMARYThe claims representative is responsible for manually reviewing and processing medical, supplemental, or dental claims. Claims are processed according to benefits, eligibility, and internal processes, policies, and procedures and may be completed, held for additional information/review, or denied. New claim representatives will be provided with a robust training program, which includes virtual classroom training, on-the-job learning/feedback, and gradually increasing claims per hour/quality requirements over several months. After completion of training, claim representatives must meet specific accuracy/quality, volume/claims per hour, and on production performance metrics.$19/Hour Pay RateRESPONSIBILITIES\xc2\xb7 Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines.\xc2\xb7 Confirm the presence of necessary documents within submitted claims.\xc2\xb7 Validate the accuracy of medical codes provided in claim submissions.\xc2\xb7 Assess the eligibility status of claims based on established criteria.\xc2\xb7 Review and verify other insurance coverage information in submitted claim.\xc2\xb7 Evaluate authorizations provided in claim submissions for accuracy.\xc2\xb7 Analyze account benefit plans to ensure claims align with coverage and policies.\xc2\xb7 Identify discrepancies, errors, or missing information.\xc2\xb7 Utilize multiple computer applications simultaneously.\xc2\xb7 Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision.\xc2\xb7 Meet or exceed quality and productivity goals.\xc2\xb7 Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows.\xc2\xb7 Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors.QUALIFICATIONS\xc2\xb7 High school diploma or equivalent\xc2\xb7 Ability to quickly learn a variety of computer applications to complete job functions,\xc2\xb7 Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook.\xc2\xb7 Knowledge of basic Microsoft Excel functions, such as filtering/sorting.\xc2\xb7 Experience in navigating multiple computer applications through the use of shortcut keys and other techniques.\xc2\xb7 Detail-oriented with experience in applying complex policy/procedure documents.\xc2\xb7 Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines.\xc2\xb7 Proven experience completing work with quality and productivity performance standards.\xc2\xb7 Experience working independently in a virtual environment preferred.\xc2\xb7 Experience with medical and insurance terminology in a professional setting preferred.\xc2\xb7 Knowledge of CPT/ICD-10 codes preferred.\xc2\xb7 Proven experience in health insurance claims processing or similar field preferredIf 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 - 25 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\xe2\x80\x99s why you\xe2\x80\x99ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you\xe2\x80\x99ll 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 .About The Cigna GroupDoing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we\xe2\x80\x99re 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.Qualified applicants with criminal histories will be considered for employment in a manner
consistent with all federal, state and local ordinances.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.

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