Researches, analyzes and calculates claims in accordance with provider contracts
Works with internal matrix partners to resolve pended claims/tickets issues
Utilizes SRS to route work items to matrix partners and external retailer claim administration staff
Follow audit protocols and workflows to ensure quality goals.
Special pricing projects as requested by retailers
Partners with matrix organizations to ensure that appropriate action is taken to identify and implement high potential process improvements
Supports and drives process improvement to further enhance claim accuracy outcomes
Engagement, partnership with supervisor, claim processing team, and other internal and external partners
Position requires excellent interpersonal skills; ability to understand and interpret policy provisions, and to present report analysis and meaningful findings in a clear, concise way.
Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams.
Identifies steps necessary to process a varying complexity of contracts for pricing accuracy
Qualifications
3 years of claim processing technical knowledge and application
Customer Service Driven; ability to meet and exceed the internal partner and external customer expectations
Take accountability in critical thinking and decision making outcomes
Problem solving skills; utilization of technical skills and resources to ensure accuracy of final claim resolution
Strong communication skills, both verbal and written
Ability to teach, educate, coach others through a variety of claim complexities
Process improvement skills; ability to assess trends, processes, and barriers to drive positive outcomes for claim resolutions
Fluent understanding and application of key tools and resources for claim processing; KnowledgeXchange, Calculators, CPF/PWB, SANP, Facets, etc.
Comfortable working with others in multiple locations; office and work at home
Basic knowledge with Word, Excel, PowerPoint, WebEx and Outlook preferred
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 19 – 28 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.
About Cigna
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
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.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.