Claims Representative - Remote
Posted 2025-08-15
Remote, USA
Full Time
Immediate Start
About the position
The Claims Representative position at The Cigna Group is a remote role focused on the manual review and processing of medical, supplemental, or dental claims. The primary responsibility of the claims representative is to ensure that claims are processed accurately according to established benefits, eligibility criteria, and internal policies and procedures. This role requires a thorough understanding of the claims process, as claims may be completed, held for additional information, or denied based on the review outcomes. New hires will undergo a comprehensive training program that includes virtual classroom sessions, on-the-job learning, and feedback, with a gradual increase in claims processing expectations over several months. After training, representatives must consistently meet specific accuracy, quality, and productivity metrics to maintain their performance standards. In this role, representatives will independently research and navigate various documents and databases to process claims accurately. They will confirm the presence of necessary documentation, validate medical codes, assess eligibility, and review other insurance coverage information. The position also involves evaluating authorizations, analyzing benefit plans, and identifying discrepancies or missing information. Representatives will utilize multiple computer applications simultaneously and must maintain a strong work ethic while working independently without close supervision. Meeting or exceeding quality and productivity goals is essential, as is the ability to identify learning opportunities for efficient claim processing techniques. The Cigna Group emphasizes a commitment to improving health and vitality, and the claims representative plays a crucial role in this mission by ensuring that claims are processed correctly and efficiently. The company values diversity and inclusion, providing equal employment opportunities regardless of various characteristics, and has a tobacco-free policy for its employees.
Responsibilities
• Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines.
,
• Confirm the presence of necessary documents within submitted claims.
,
• Validate the accuracy of medical codes provided 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, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision.
,
• Meet or exceed quality and productivity goals.
,
• Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows.
,
• Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors.
Requirements
• High school diploma or equivalent.
,
• Ability to quickly learn a variety of computer applications to complete job functions.
,
• Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook.
,
• Knowledge of basic Microsoft Excel functions, such as filtering/sorting.
,
• Experience in navigating multiple computer applications through the use of shortcut keys and other techniques.
,
• Detail-oriented with experience in applying complex policy/procedure documents.
,
• Strong organizational skills to maximize available work time and prioritize tasks to ensure job tasks are completed before deadlines.
,
• Proven experience completing work with quality and productivity performance standards.
,
• Experience working independently in a virtual environment preferred.
,
• Experience with medical and insurance terminology in a professional setting preferred.
,
• Knowledge of CPT/ICD-10 codes preferred.
,
• Proven experience in health insurance claims processing or similar field preferred.
Nice-to-haves
• Experience working independently in a virtual environment preferred.
,
• Experience with medical and insurance terminology in a professional setting preferred.
,
• Knowledge of CPT/ICD-10 codes preferred.
,
• Proven experience in health insurance claims processing or similar field preferred.
Benefits
• $19/Hour Pay Rate Apply tot his job
The Claims Representative position at The Cigna Group is a remote role focused on the manual review and processing of medical, supplemental, or dental claims. The primary responsibility of the claims representative is to ensure that claims are processed accurately according to established benefits, eligibility criteria, and internal policies and procedures. This role requires a thorough understanding of the claims process, as claims may be completed, held for additional information, or denied based on the review outcomes. New hires will undergo a comprehensive training program that includes virtual classroom sessions, on-the-job learning, and feedback, with a gradual increase in claims processing expectations over several months. After training, representatives must consistently meet specific accuracy, quality, and productivity metrics to maintain their performance standards. In this role, representatives will independently research and navigate various documents and databases to process claims accurately. They will confirm the presence of necessary documentation, validate medical codes, assess eligibility, and review other insurance coverage information. The position also involves evaluating authorizations, analyzing benefit plans, and identifying discrepancies or missing information. Representatives will utilize multiple computer applications simultaneously and must maintain a strong work ethic while working independently without close supervision. Meeting or exceeding quality and productivity goals is essential, as is the ability to identify learning opportunities for efficient claim processing techniques. The Cigna Group emphasizes a commitment to improving health and vitality, and the claims representative plays a crucial role in this mission by ensuring that claims are processed correctly and efficiently. The company values diversity and inclusion, providing equal employment opportunities regardless of various characteristics, and has a tobacco-free policy for its employees.
Responsibilities
• Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines.
,
• Confirm the presence of necessary documents within submitted claims.
,
• Validate the accuracy of medical codes provided 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, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision.
,
• Meet or exceed quality and productivity goals.
,
• Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows.
,
• Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors.
Requirements
• High school diploma or equivalent.
,
• Ability to quickly learn a variety of computer applications to complete job functions.
,
• Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook.
,
• Knowledge of basic Microsoft Excel functions, such as filtering/sorting.
,
• Experience in navigating multiple computer applications through the use of shortcut keys and other techniques.
,
• Detail-oriented with experience in applying complex policy/procedure documents.
,
• Strong organizational skills to maximize available work time and prioritize tasks to ensure job tasks are completed before deadlines.
,
• Proven experience completing work with quality and productivity performance standards.
,
• Experience working independently in a virtual environment preferred.
,
• Experience with medical and insurance terminology in a professional setting preferred.
,
• Knowledge of CPT/ICD-10 codes preferred.
,
• Proven experience in health insurance claims processing or similar field preferred.
Nice-to-haves
• Experience working independently in a virtual environment preferred.
,
• Experience with medical and insurance terminology in a professional setting preferred.
,
• Knowledge of CPT/ICD-10 codes preferred.
,
• Proven experience in health insurance claims processing or similar field preferred.
Benefits
• $19/Hour Pay Rate Apply tot his job