POSITION SUMMARY

This position will input claim requests into an adjudication platform maintaining compliance to performance guarantees, HIPPA guidelines and service standards.  Create correspondence to members, internal departments, and external agencies regarding outstanding claims issues as appropriate. Process claims submitted by members, pharmacies or appropriate agencies as needed according to client guidelines.  May work on special projects for claims team.

Primary Functions

• Handle claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issues. Work with other operational departments to research and resolve claims issues within performance agreement guidelines.
• Create correspondence to members, internal departments, and external agencies regarding outstanding claims issues. Compose letters to members or pharmacies for those claims with insufficient information or eligibility or benefit issues.
• Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member’s address to match claim form if necessary.
• Input claim requests into adjudication platform maintaining production and accuracy standards. Evaluate system rejections to ensure accuracy and appropriateness
• Identify exception handling and process per client requirements. When appropriate, assign a script number or NDC number if not provided.
• Recognize repetitive problems or issues and escalate as needed.
• Special projects as needed.

Key Qualifications

• High School Diploma or equivalent
• 2 years relevant claims processing experience preferred
• Strong 10-key data entry skills with high level of accuracy
• Proficient with MS Office software
• Strong attention to detail
• Strong written and oral communication skills
• Strong customer focus
• Ability to adapt in a dynamic work environment, learn quickly, solve problems and complete tasks with minimal supervision

This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

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: 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.