Claim Lead Representative, Payer Solutions - Evernorth- Remote

The Cigna Group; United States; Remote; Full time

Job summary

A leading company is seeking a Claims Lead Representative to manage claims processing and collaborate with internal teams. This role offers the flexibility of remote work and requires strong analytical and communication skills. The position comes with a competitive hourly rate and comprehensive benefits, supporting professional growth and a commitment to equal employment opportunities.

Benefits

Medical benefits

Vision benefits

Dental benefits

401(k) with match

Paid time off

Qualifications

• At least 1 year of technical experience in Payer Solutions claim processing.
• Ability to teach and coach others on claim processes.

Responsibilities

• Research, analyze, and calculate claims in accordance with provider contracts.
• Collaborate with internal partners to resolve pended claims/issues.

Skills

Customer service

Critical thinking

Problem-solving

Communication

Process improvement

Tools

C-Kit 2.0

Calculators

Facets

Job description

The job profile for this position is Claims Lead Representative, which is a Band 2 Professional Career Track Role.

Excited to grow your career?

We value our talented employees and strive to help our associates grow professionally before recruiting new talent. 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.

Note: Any Work at Home location is acceptable for this position.

Responsibilities:

1. Research, analyze, and calculate claims in accordance with provider contracts.
2. Collaborate with internal partners to resolve pended claims/issues.
3. Use our SRS system to route work items to relevant teams.
4. Follow audit protocols to ensure quality standards.
5. Handle special pricing projects as requested by retailers.
6. Partner with teams to identify and implement process improvements.
7. Support and promote process enhancements for claim accuracy.
8. Engage with supervisors and teams to ensure effective communication and partnership.
9. Understand and interpret policy provisions; present analysis clearly.
10. Identify pricing errors and coordinate resolutions with internal teams.
11. Process contracts of varying complexity for pricing accuracy.

Qualifications:

1. At least 1 year of technical experience in Payer Solutions claim processing.
2. Customer service-oriented with the ability to meet expectations.
3. Accountability in critical thinking and decision-making.
4. Problem-solving skills with technical resource utilization.
5. Strong verbal and written communication skills.
6. Ability to teach and coach others on claim processes.
7. Skills in process improvement and trend analysis.
8. Proficiency with tools like C-Kit 2.0, Calculators, CPF/PWB, SANP, Facets, etc.
9. Comfortable working in multiple locations, including remote work.
10. Basic knowledge of Word, Excel, PowerPoint, WebEx, and Outlook.

Work from Home Requirements: A broadband or fiber internet connection with at least 10Mbps download and 5Mbps upload speeds is required.

The hourly rate is anticipated to be $22-$33 USD, based on experience and location, with eligibility for an annual bonus.

We offer comprehensive benefits including medical, vision, dental, well-being programs, 401(k) with match, paid time off, and more. For details, visit Life at Cigna.

We are committed to equal employment opportunity and consider qualified applicants without regard to race, color, age, disability, sex, pregnancy, sexual orientation, gender identity, veteran status, religion, national origin, marital or familial status, genetic information, citizenship, or other protected characteristics.

Please ensure your application meets our posting guidelines, available at the provided link. Qualified applicants with criminal histories will be considered in accordance with applicable laws.