Claims Representative – Remote Jobs
Job Description
Job Type: Claims Representative from home
Location: Texas work from home
Company: Cigna
Provides simple administrative and/or other fundamental business services for claims. examines and processes claims made on paper or electronically. decides whether to pay claims in accordance with policies or return, pend, or deny them. identifies the actions required for adjudication. Claims are resolved with claimants in line with the terms of the policy. evaluates the completeness and validity of the claim by comparing the claim application and/or provider statement with the policy file and other documents. Contacts claimants and agents through phone or mail to address mistakes or omissions on claim forms and to look into ambiguous entries. Problems typically have a routine nature. good familiarity and comprehension with business/operating processes and procedures as well as claims. works under careful supervision and following precisely established protocols.
Representatives for claims
By ensuring that medical claims are processed accurately, promptly, and with the utmost respect for the privacy of our customers’ personal health information, we can assist our customers in maintaining their health, well-being, and sense of security. Performs tasks related to the claims adjudication process, including reviewing the claim form, confirming eligibility, checking the coordination of benefits with insurance carriers, and concluding in accordance with the health benefits plan, all under direct supervision. Technical coaches will offer guidance and support on a technical level.
Responsibilities:
- Review claim submissions to ensure that all necessary paperwork has been received, and to check benefit plans, medical codes, eligibility, and other insurance and authorizations.
- Complies with established policies and processes to pay, hold for more details, or reject claims.
- Accept feedback with a growth mentality so you can keep getting better. This will help you adapt to change and positively affect it.
- In order to meet or surpass Key Performance Indicators (KPI), follow procedures and work autonomously.
- Using a range of virtual tools, such as Outlook email, Skype for Business, Cisco Web-Ex, or other comparable programs, the ability to successfully excel in a virtual work environment through active involvement in team huddles, Supervisor 1×1 or check-ins.
- Keeps a high standard of accuracy in all tasks carried out.
- The Management Operating Systems (MOS) tools, Daily Production Log (DPL), Performance Profile, Claim Review tool, and other reporting systems will be used to hold team members accountable for achieving and maintaining minimal quality and production standards.
- On Workflow Tool (WFT), pending claims, or other inventory issues, collaborate with the Resource Management Group (RMG).
- Working together, you can comprehend claim procedures and processes.
Requirements:
- Must have excellent problem-solving abilities and a great attention to detail.
- High level of proficiency with computer navigation, including knowledge of shortcut keys
- Proficient in Word, Excel, Outlook, OneNote, and Power Point from Microsoft Office
- Understanding of CPT/ICD-10 codes and other terms used in the medical and insurance industries
- Superior interpersonal, organizational, writing, and vocal communication skills
- A track record of providing excellent customer service
- Comfortable performance in a work atmosphere that is deadline-driven and fast-paced.
- Ability to type on a keyboard and use it for extended periods of time
- Integrity and personal responsibility for meeting obligations and standards in work
- A track record of learning a range of benefit plans
If you intend to work from home on a regular basis or infrequently, you must have an internet connection from a cable broadband or fiber optic internet service provider with minimum download and upload speeds of 10 Mbps and 5 Mbps, respectively.
We anticipate paying between 17 and 26 USD per hour for this work, based on pertinent aspects like experience and location.
Additionally, it is anticipated that this position will qualify for the yearly bonus program.
