Claims Representative

Cigna Health and Life Insurance Company; Pennsylvania; Hybrid; USD 23,000 - 36,000; Full time

Benefits offered by this job

Health benefits

401(k)

Life insurance

Tuition reimbursement

Paid time off

Paid holidays

Leaves of absence

Job summary

The Cigna Group is hiring a Claims Representative to process Supplemental Health claims with accuracy and timeliness. This band 1 professional role supports customers by adjudicating claims in alignment with plan provisions while protecting confidential information.

Training includes virtual classroom, coaching, and gradual performance growth, with ongoing performance standards. Responsibilities include reviewing submissions, verifying eligibility, following policies, and maintaining

Qualifications

• Must possess strong attention to detail and problem-solving skills with a high level of accuracy.
• Proficient in Microsoft Office: Word, Excel, Outlook, OneNote, PowerPoint.
• Excellent organizational, interpersonal, written and verbal communication skills.
• Ability to prioritize tasks to meet deadlines.
• Experience delivering exceptional customer service.

Responsibilities

• Independently review claim submissions to confirm required documents have been received and verify codes, eligibility, and coverage.
• Follow policies to pay, pend, or deny claims.
• Maintain accuracy and meet KPI targets in a virtual environment.
• Use multiple computer applications simultaneously and manage workflow tools.
• Identify discrepancies or missing information and escalate as needed.

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. Our people make all the difference in our success.

Claims Representative

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.
• Follow 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.
• Maintain 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.

Hourly rate 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.

Benefits

• Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well‑being and behavioral health programs.
• We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence.

For more details on our employee benefits programs.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re 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 need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.