Claims Representative

Cigna Health and Life Insurance Company; Northern (KY); Hybrid; USD 24,000 - 36,000; Full time

Benefits offered by this job

Annual bonus plan

Remote work option

Job summary

Cigna Health and Life Insurance Company is seeking a Claims Representative to review, adjudicate, and finalize Supplemental Health claims with accuracy and timeliness. The role supports confidential customer information and requires strong attention to detail and problem-solving in a fast-paced environment.

The position includes on-the-job coaching after a structured training program, with expectations to meet quality and productivity standards while working virtually.

Qualifications

• High School diploma or equivalent.
• Strong attention to detail and problem-solving skills.
• Proficient with multiple computer applications including Word, Excel, Outlook, OneNote and PowerPoint.

Responsibilities

• Review claim submissions to confirm documents are received and verify codes, eligibility, and coverage.
• Pay, pend, or deny claims following policy guidelines.
• Maintain accuracy and confidentiality while working in a fast-paced environment.
• Communicate effectively with customers and team members.

Skills

Attention to detail

Problem solving

Microsoft Office

CPT/ICD-10 codes

Organizational skills

Interpersonal communication

Written communication

Time management

Customer service

Education

High School diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Outlook

OneNote

PowerPoint

Job description

**Claims Representative****Job Description**The job profile for this position is Claims Representative, which is a Band 1 Professional Career Track role.**Excited to grow your career?**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 Representative**Help customers maintain their financial well-being and peace of mind by accurately and timely processing Supplemental Health claims while safeguarding confidential customer information. SHS Claim Representatives support customers experiencing unexpected accidents, illnesses, and hospital stays by adjudicating claims and ensuring benefits are administered according to plan provisions.Under direct supervision, advocates perform duties related to the adjudication of Supplemental Health claims, including reviewing claim documentation, verifying eligibility and coverage, interpreting policy provisions, determining benefit eligibility, managing pending claims, and issuing claim decisions. New advocates participate in a structured training program that includes virtual classroom instruction, on-the-job coaching, and gradual increases in productivity and quality expectations. Upon completion of training, advocates are expected to meet established quality, productivity, and performance standards.**Responsibilities*** Independently 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 an on camera virtual work environment through active participation in team huddles, Supervisor 1x1 or check-ins, using a variety of virtual tools, i.e. Outlook email, TEAMS for Business, Cisco Web-Ex or other similar applications.* Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision.* Maintains a high level of accuracy in all duties performed.* Utilize multiple computer applications simultaneously.* Identify discrepancies, errors, or missing information.* Team members will be held accountable for meeting and maintaining minimum quality and production standards through use of Management Operating Systems (eMOS) tools: Daily Production Log (DPL), Performance Profile, Ring Master, SAM3, and other reporting systems.* Partner with the Resource Management Group (RMG) on Workflow Tool (WFT), COGNOS pend report claims, or other inventory issues.* Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows.* Work independently in a virtual environment while demonstrating accountability, professionalism, and strong time management skills.* Maintain confidentiality and compliance with company policies and regulatory requirements.**Experience Required:*** High School diploma or equivalent* Must possess strong attention to detail and problem-solving skills with a high level of accuracy* High level of navigating multiple computer applications using shortcut keys and other techniques* Proficient in Microsoft Office applications, Word, Excel, Outlook, OneNote, and Power Point* Knowledge of medical and insurance industry terminology including CPT/ICD-10 codes required* Proven experience in health insurance claims processing or similar field preferred* Excellent organizational, interpersonal, written and verbal communication skills* Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines* 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* Ability to interpret policy language and apply complex benefit provisions 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 17.75 - 26 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.