Claims Representative - Remote

The Cigna Group

Job Overview

Location

2 Locations

Job Type

Full-time

Full Job Description

📋 Description

• Independently review and process medical, supplemental, and dental claims in accordance with benefits, eligibility criteria, and internal policies and procedures.
• Research and navigate multiple databases and documents to verify claim accuracy, compliance, and completeness.
• Confirm the presence and validity of required documentation submitted with each claim.
• Validate the accuracy of medical coding (e.g., CPT/ICD-10) provided in claim submissions.
• Assess patient eligibility status based on established plan criteria and coverage rules.
• Review and verify information regarding other insurance coverage associated with submitted claims.
• Evaluate the accuracy and applicability of pre-authorizations included in claim submissions.
• Analyze account benefit plans to ensure claims align with policy terms and coverage limits.
• Identify discrepancies, errors, missing information, or inconsistencies in claim data.
• Utilize multiple computer applications simultaneously, including Outlook, Cisco Webex, and other virtual tools, to perform daily tasks and maintain communication.
• Maintain self-discipline and strong work ethic while working independently in a remote environment without close supervision.
• Meet or exceed established quality, accuracy, and productivity metrics, including claims per hour and error rate targets.
• Participate in a structured training program that includes virtual classroom instruction, on-the-job learning, and progressive performance expectations.
• Collaborate with supervisors, coaches, and trainers to identify opportunities for improving claim processing efficiency and effectiveness.
• Apply complex policy and procedure documents with high attention to detail to ensure correct claim adjudication.
• Prioritize and organize tasks effectively to meet deadlines and maintain consistent workflow in a fast-paced environment.
• Ensure all work adheres to performance standards for quality and productivity, with ongoing evaluation against key metrics.
• Maintain proficiency in basic Microsoft Excel functions such as filtering and sorting to support claim analysis and reporting.
• Use keyboard shortcuts and efficient navigation techniques to manage multiple applications during claim processing.
• Maintain a reliable high-speed internet connection with minimum speeds of 10Mbps download and 5Mbps upload for remote work.

🎯 Requirements

• High school diploma or equivalent
• Experience sending/receiving emails, scheduling calendar appointments, and attaching files in Microsoft Outlook
• Knowledge of basic Microsoft Excel functions (e.g., filtering, sorting)
• Experience navigating multiple computer applications using shortcut keys and efficient techniques
• Detail-oriented with proven ability to apply complex policy and procedure documents
• Strong organizational skills and ability to prioritize tasks to meet deadlines

🏖️ Benefits

• Hourly pay rate of $17.75–$26, depending on experience and geographic location
• Eligibility to participate in an annual bonus plan
• Medical, dental, and vision insurance coverage starting on day one
• 401(k) plan with company contributions
• Company-paid life insurance
• Minimum of 18 days of paid time off per year
• Paid holidays and leaves of absence
• Tuition reimbursement
• Well-being and behavioral health programs

Skills & Technologies

Fiber

Remote

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The Cigna Group

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About The Cigna Group

The Cigna Group is a global health services company formed in 1982 through the merger of Connecticut General and INA Corporation. It provides medical, dental, disability, life and accident insurance, pharmacy benefit management, and behavioral health services to employers, individuals and government entities. Headquartered in Bloomfield, Connecticut, the company operates in over 30 countries and jurisdictions, serving more than 180 million customer relationships worldwide through its subsidiaries and affiliates.

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