remote type
Remote
locations
United States Work at Home
time type
Full time
posted on
Posted 2 Days Ago
job requisition id
23003786
The Claims Senior Representative identifies necessary steps and processes claims of varying complexity levels. Using complex systems to research, analyze, and price claims in accordance with processing guidelines as well as provider and customer contracts.
The Claims Senior Representative will work with the Claims Manager to develop policies, procedures and the business work plan for the team and recommend operational improvements when appropriate.
Primary Job Responsibilities
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/educating the necessary parties. Provides recommendations regarding process improvements
Use influencing skills with peers to support organizational change initiatives
Performing activities such as leading team in initiatives or special projects
Works independently and takes the initiative in completing work assignments and other project work.
Demonstrates Customer Centric attributes and associated behaviors to deliver exceptional customer experiences
Coaches and supports their peers and takes a leadership role in execution of claim initiatives.
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 leading team huddles, special projects, supporting supervisor as requested.
Collaboratively works with supervisor to develop, prepare oneself to be ready for next business opportunity.
Working with the managers of those markets as well as Network Operations, Provider Data Management (PDM) and Configuration to assess root cause and remediation
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
High School Diploma required, A
3+ years’ experience in a Medicare claims processing environment required
Medical coding certification or 2+ years of equivalent experience required
Proficiency with computer applications including Microsoft Office, Internet, and email
Strong knowledge of Medicare regulatory requirements and ability to work independently to identify root cause and solution to claims issues, and driving the initiative to correct it with minimal guidance
Demonstrated leadership skills and the ability to develop, train and coach less experienced team members with the patience to explain details and processes repeatedly.
Excellent communication, interpersonal and negotiation skills required along with listening and written communication skills.
Ability to adapt in a dynamic work environment and make independent decisions
Ability to drive change and process improvements required
Strong time management skills required
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an hourly rate of 18 – 27 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.