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Claims Analyst

CategoryCustomer Service & Claims
Job typeFull Time
CountryUnited States
**Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.

The job profile for this position is Claims Lead Representative which is a Band 2 Professional Career Track role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

Claims Lead Representatives

Help our customers maintain their health, well-being and sense of security by ensuring complex medical claims are processed accurately and timely for healthcare providers and policy holders while protecting the confidentiality of our customer's personal health information. Under minimal supervision performs duties relating to the claims adjudication process while leading special projects, acting as a subject matter expert, and providing knowledge to team members.

  • Review claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.
  • Follows established policies and procedures to pay, pend for additional information, or deny claims.
  • Identifies error trends notifying appropriate areas for correction
  • Provides leadership support to peers in claim knowledge and execution.
  • Leads special projects and acts as a champion for change initiatives.
  • Exhibits a superior level of professionalism and knowledge while partnering with internal partners.
  • Follow processes and work independently to meet or exceed Key Performance Indicators (KPI)
  • Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1x1 or check-ins, using a variety of virtual tools, i.e. Outlook email, Skype for Business, Cisco Web-Ex or other similar applications.
  • Relentlessly pursue a high level of accuracy in all duties performed.
  • Maintains excellent quality and production standards through use of Management Operating Systems (MOS) tools: Daily Production Log (DPL), Performance Profile, Claim Review tool, and other reporting systems.

Experience Required:
  • Leadership skills to support supervisors and encourage growth of peers
  • Must possess strong attention to detail and problem-solving skills with a high level of accuracy
  • Proficient in Microsoft Office applications, Word, Excel, Outlook, OneNote, and Power Point
  • Knowledge of medical and insurance industry terminology including CPT/ICD-10 codes
  • Excellent organizational, interpersonal, written and verbal communication skills
  • Possess the ability to work across multiple skill levels (Skill 1, 2, 3, COB, Duplicates, Medicare) and/or platforms (Proclaim, Facets, PMHS) is a plus
  • Ability to perform comfortably in a fast-paced, deadline-oriented work environment
  • Must be able to type and use a keyboard for extended periods of time
  • Integrity and personal accountability for job performance and expectations

This position is not eligible to be performed in Colorado.

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.
Employer091 Cigna Health & Life Ins. Co.

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