Claims Representative - Remote

The Cigna Group; Tennessee; Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company in health services is seeking a Claims Representative to work remotely. This role involves processing medical claims, ensuring compliance with guidelines, and meeting productivity metrics. Candidates should have a high school diploma and experience in health insurance claims processing is preferred. The company offers a comprehensive training program and various benefits including medical, dental, and 401(k).

Benefits

Medical benefits

Vision benefits

Dental benefits

401(k) with match

Paid time off

Holidays

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 accurately process claims.
• Verify necessary documents and validate medical codes.
• Meet or exceed quality and productivity goals.

Skills

Detail-oriented

Organizational skills

Ability to learn computer applications

Knowledge of medical terminology

Education

High school diploma or equivalent

Tools

Microsoft Outlook

Microsoft Excel

Job description

4 days ago Be among the first 25 applicants

Job Title: 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 sessions, on-the-job learning, feedback, and gradually increasing claims volume and quality standards over several months. After training, representatives must meet specific accuracy, quality, volume, and productivity metrics.

Responsibilities

• Research and navigate various documents and databases to accurately process claims, ensuring compliance with guidelines.
• Verify the presence of necessary documents within claims.
• Validate medical codes in claim submissions.
• Assess claim eligibility based on established criteria.
• Review insurance coverage information in claims.
• Evaluate authorizations for accuracy.
• Analyze account benefit plans to ensure claims align with coverage policies.
• Identify discrepancies, errors, or missing information.
• Utilize multiple computer applications simultaneously.
• Work independently with discipline, uphold a strong work ethic, and complete tasks without close supervision.
• Meet or exceed quality and productivity goals.
• Work with supervisors and trainers to identify learning opportunities and improve processing techniques.
• Use virtual tools like Outlook, Cisco Webex, etc., to communicate and collaborate effectively.

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 ability to apply complex policies
• Strong organizational skills and ability to prioritize tasks
• Proven track record of meeting quality and productivity standards
• 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

For remote work, internet connection must be via cable broadband or fiber optic with speeds of at least 10Mbps download/5Mbps upload.

Pay rate: $17.75 - $25/hour, depending on experience and location. Eligible for an annual bonus plan.

Benefits include medical, vision, dental, well-being programs, 401(k) with match, paid time off, holidays, and more. For details, visit 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 to make a difference.

We are an equal opportunity employer and consider all qualified applicants without regard to race, color, age, disability, sex, or other protected characteristics. For reasonable accommodations, contact [e-mail].