Employer: Cigna
The Claims Senior Representative identifies necessary steps and processes claims of varying levels according to the customer’s contract. This level is typically responsible for independently reviewing UB and HCFA complex or specialty claims, able to analyze research and price claims in accordance with processing guidelines. The Claims Senior Representative participates in team meetings to identify opportunities to improve claims processing and recognize trends.
Primary Job Duties:
- Demonstrates the ability to pay claims across all claim types as required by business need
- Responsible for researching and resolving escalated and complex claim issues in a timely manner.
- Identifies error trends and notifies the appropriate areas for correction communicating with the necessary parties
- Works independently and takes the initiative in completing work assignments
- Demonstrates Customer Centric attributes and associated behaviors to deliver exceptional customer experiences
- Provides a superior level of professionalism and knowledge when communicating with internal matrix partners and external customers
- Embraces the virtual work environment through active participation in virtual team huddles, Barrier Time Conversations and monthly 1×1’s, usage of the virtual tools including but not limited to, Lync, email, web ex, . Readily identifies any virtual barrier to their supervisor.
- Demonstrates initiative to take on additional tasks and work as needed, including but not limited to, special projects, supporting supervisor as requested.
- Collaboratively works with supervisor to develop, prepare oneself to be ready for next business opportunity.
- Participates in operational meetings and training sessions as necessary
- Ensure privacy and confidentiality as required by HIPAA, company and departmental guidelines.
- Other special projects and tasks as assigned.
Qualifications:
US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at [email protected].
Qualifications:
- High School Diploma or equivalent required
- 3+ years of Medicare claims processing experience working with QNXT Operating systems required
- Demonstrated experience analyzing and resolving customer issues
- Hands on experience working with edit based systems is a plus
- Demonstrated proficiency using a Computer, Microsoft Outlook ,Excel, and high level capacity to multitask independently
- Excellent communication, interpersonal and negotiation skills required along with listening and written communication skills.
- Ability to perform in a high volume, fast paced claims environment
- Strong time management skills required
For this position, we anticipate offering an hourly rate of $18 – $27, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.