Claims Representative

Cigna Healthcare•Pennsylvania Work at Home, PA

1d•$18 - $26•Remote

About The Position

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.

Requirements

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

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.