Claims Representative

The Cigna Group

Claims Representative responsible for processing medical and dental claims at The Cigna Group. Collaborating virtually to ensure compliance and quality in claims management.

Posted 5/28/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $19 per hourWebsite

About the role

Key responsibilities & impact

Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines
Confirm the presence of necessary documents within submitted claims
Validate the accuracy of medical codes provided in claim submissions
Assess the eligibility status of claims based on established criteria
Review and verify other insurance coverage information in submitted claim
Evaluate authorizations provided in claim submissions for accuracy
Analyze account benefit plans to ensure claims align with coverage and policies
Identify discrepancies, errors, or missing information
Utilize multiple computer applications simultaneously
Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision
Meet or exceed quality and productivity goals
Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows
Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors

Requirements

What you’ll need

High school diploma or equivalent
Ability to quickly learn a variety of computer applications to complete job functions
Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook
Knowledge of basic Microsoft Excel functions, such as filtering/sorting
Experience in navigating multiple computer applications through the use of shortcut keys and other techniques
Detail-oriented with experience in applying complex policy/procedure documents
Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines
Proven experience completing work with quality and productivity performance standards
Experience working independently in a virtual environment preferred
Experience with medical and insurance terminology in a professional setting preferred
Knowledge of CPT/ICD-10 codes preferred
Proven experience in health insurance claims processing or similar field preferred

Benefits

Comp & perks

medical, vision, dental, and well-being and behavioral health programs
401(k)
company paid life insurance
tuition reimbursement
minimum of 18 days of paid time off per year
paid holidays

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical codingCPT codesICD-10 codesclaims processingMicrosoft Exceldocument navigationpolicy applicationdata validationinsurance coverage assessmentaccount benefit analysis

Soft Skills

detail-orientedorganizational skillsself-disciplinestrong work ethicindependent worktime managementcommunicationcollaborationproblem-solvingadaptability