Claims Representative - Remote

The Cigna Group; Philadelphia (Philadelphia County); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare company is seeking a Claims Representative to manually review and process medical claims. This role requires attention to detail and the ability to navigate multiple computer applications. Successful candidates will undergo comprehensive training and must meet specific performance metrics. Benefits include health coverage and a 401(k) plan.

Benefits

Health coverage

401(k) with match

Paid time off

Annual bonuses

Qualifications

• High school diploma or equivalent required.
• Experience in health insurance claims processing preferred.
• Detail-oriented with strong organizational skills.

Responsibilities

• Research and navigate documents to process claims accurately.
• Validate accuracy of medical codes in submissions.
• Meet or exceed quality and productivity goals.

Skills

Detail-oriented

Organizational skills

Ability to learn computer applications

Knowledge of medical terminology

Knowledge of CPT/ICD-10 codes

Education

High school diploma or equivalent

Tools

Microsoft Outlook

Microsoft Excel

Job description

4 days ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Summary

The 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. They may be completed, held for additional information/review, or denied. New claim representatives will undergo a comprehensive training program, including virtual classroom training, on-the-job learning/feedback, and gradually increasing claims per hour/quality requirements over several months. After training, representatives must meet specific accuracy/quality, volume/claims per hour, and performance metrics.

Claims Representative – Remote

Summary

The 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. They may be completed, held for additional information/review, or denied. New claim representatives will undergo a comprehensive training program, including virtual classroom training, on-the-job learning/feedback, and gradually increasing claims per hour/quality requirements over several months. After training, representatives must meet specific accuracy/quality, volume/claims per hour, and performance metrics.

Pay Rate: $19/Hour

Responsibilities

• Research and navigate various documents and databases to accurately process claims, ensuring compliance with guidelines.
• Confirm the presence of necessary documents within submitted claims.
• Validate the accuracy of medical codes in claim submissions.
• Assess the eligibility status of claims based on established criteria.
• Review and verify other insurance coverage information in submitted claims.
• Evaluate authorizations provided in claim submissions for accuracy.
• Analyze account benefit plans to ensure claims align with coverage and policies.
• Identify discrepancies, errors, or missing information.
• Utilize multiple computer applications simultaneously.
• Maintain self-discipline, uphold a strong work ethic, and complete tasks independently.
• Meet or exceed quality and productivity goals.
• Work with supervisors, coaches, and trainers to identify learning opportunities and improve processing techniques.
• Use virtual tools like Outlook, Cisco Webex, etc., for collaboration and communication.

Qualifications

• High school diploma or equivalent.
• Ability to quickly learn various computer applications.
• Experience with email, scheduling, and attaching files in Microsoft Outlook.
• Basic knowledge of Microsoft Excel functions.
• Experience navigating multiple applications using shortcut keys.
• Detail-oriented with experience applying complex policies.
• Strong organizational skills and ability to prioritize.
• Proven track record of quality and productivity.
• Experience working independently in a virtual environment preferred.
• Knowledge of medical and insurance terminology preferred.
• Knowledge of CPT/ICD-10 codes preferred.
• Experience in health insurance claims processing preferred.

Note: Reliable internet connection (cable broadband or fiber optic, at least 10Mbps download/5Mbps upload) is required if working remotely.

Pay range: $17.75 - $25/hour, depending on experience and location. Eligible for annual bonuses.

Benefits include health coverage, 401(k) with match, paid time off, holidays, and more. Details at Life at Cigna Group.

About The Cigna Group

We are dedicated to improving health and vitality through our divisions Cigna Healthcare and Evernorth Health Services. Join us in making a difference.

We are an equal opportunity employer and consider applicants without regard to race, color, age, disability, sex, and other protected characteristics. Reasonable accommodations are available upon request.

Additional Information

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Finance and Sales
• Industries: Hospitals and Healthcare