Job description

Help our customers maintain their health, well-being and sense of security by providing swift, accurate evaluation of the various Cigna Supplemental Health products, including Hospital Care, Accidental Injury and Critical Illness. This position is responsible for identifying, preparing and processing claims for Cigna customers enrolled in Supplemental Health products. Responsibilities include reviewing daily claim reports, checking eligibility, initiating and adjudicating member claims, and reporting. Additionally, these team members will work with the claims and call center/processing teams to identify reporting and claim issues while working to resolve them in a timely manner. In the future, these team members will also support the testing of innovative product solutions.

Responsibilities

Review incoming Cigna claim files to determine member eligibility.

Determine clients’ eligibility for benefit payout based on claim and associated policy.

Once coverage is confirmed, process a claim on the member’s behalf.

Update all systems and files to ensure accurate record keeping.

Maintain strict compliance when accessing PHI/PII.

Ensure all claim data is properly documented and saved in the appropriate folders.

Identify opportunities for process improvements and offer solutions to expedite the claims review process.

Meet all Compliance regulations and complete claims within established time frames.

Ability to multi-task and seamlessly transition between product types throughout the day.

Evaluates eligibility, benefit amounts based on contract policies, including determining multiple benefits that may or may not be payable on an individual claim.

Reviews and interprets claim documents against the applicable contract provisions including exclusions, limitations, material misrepresentations and fraud for all three products.

Meets and exceeds performance metrics for quality, accuracy, turn-around time and compliance requirements. This includes meeting all Performance Guarantees with clients.

Demonstrates knowledge of policies and procedures, Knowledge Exchange articles, and Corporate Compliance Policies, privacy guidelines and best practice procedures and continues to keep current with updates and changes to those requirements.

Complies with all ongoing training associated with role and business needs.

Demonstrates solid planning and organizational skills with the ability to address short and long term goals while prioritizing and addressing ongoing issues.

Supports customer centricity by proactively identifying customer needs and creating innovative solutions to meet customer challenges. Looks for new ways to accomplish objectives and takes extra steps to deliver customer service that meets and exceeds expectations.

Demonstrates ability to understand, interpret and effectively communicate contractual language.

Qualifications

Bachelor’s degree or equivalent work experience is preferred.

2+ years prior experience reviewing and interpreting claims data.

Prior experience working within a claims environment.

Demonstrated ability to manage multiple projects with strict timelines and dynamic priorities.

Advanced knowledge of MS Word and Excel is required.

Strong oral and written communication skills.

Demonstrated ability to problem solve and utilize analysis, experience and judgment to make accurate decisions.

Clear and concise and timely professional communications using all mediums.

Experience in delivering exceptional customer service.

Strong drive for results.

Team oriented focus with ability to perform at the highest level.

Maintains professionalism and flexibility despite conflicting demands.

Ability to learn process and product information and adapt quickly and effectively.

Excellent interpersonal, organizational, and conflict resolution skills.

Integrity, objectivity and personal accountability.

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 23 - 35 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 Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group 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.

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