Claims Representative (Healthcare Claims)

Location: Remote work from Pennsylvania, United States. Home internet must use cable broadband or fiber optic service with at least 10 Mbps download and 5 Mbps upload speeds.

Salary: $17.75–$26 per hour, depending on experience and geographic location. The role may also qualify for an annual bonus plan.

Company

Provides health-related services through Cigna Healthcare and Evernorth Health Services, focused on improving the health and vitality of customers and patients.

What you will do

• Review and manually process medical, supplemental, and dental claims according to benefits, eligibility, policies, and procedures.
• Research documents and databases, confirm required documentation, and identify discrepancies, errors, or missing information.
• Validate medical codes, authorizations, other insurance coverage, account benefit plans, and claim eligibility.
• Use multiple computer applications and virtual collaboration tools, including Microsoft Outlook and Cisco Webex.
• Work independently while meeting accuracy, quality, claims-per-hour, and productivity targets.
• Develop processing efficiency by working with supervisors, coaches, and trainers during and after training.

Requirements

• High school diploma or equivalent.
• Ability to learn and use multiple computer applications, including Microsoft Outlook and basic Microsoft Excel functions such as filtering and sorting.
• Experience navigating multiple applications, using shortcut keys, and working with email, calendar invitations, and file attachments.
• Strong attention to detail, organization, prioritization, and ability to apply complex policies and procedures.
• Experience meeting quality and productivity standards and working independently in a virtual environment.
• Experience with medical or insurance terminology, CPT/ICD-10 codes, or health insurance claims processing is preferred.

Culture & Benefits

• Comprehensive training includes virtual classroom instruction, on-the-job learning, feedback, and gradually increasing production expectations.
• Health, vision, dental, well-being, and behavioral health benefits are available from the first day of employment.
• Includes 401(k), company-paid life insurance, tuition reimbursement, at least 18 days of paid time off per year, paid holidays, and leaves of absence.
• Tobacco-free policy applies, including in Pennsylvania and other listed states.