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Health Claims Examiner

Claims SpecialistClaims SpecialistOtherRemoteSeniorTeam 10,001+Since 1982H1B No SponsorCompany SiteLinkedIn

Location

Montana

Posted

101 days ago

Salary

0

Seniority

Senior

High SchoolEnglish

Job Description

Health Claims Examiner

The Cigna Group

• Responsible for the accurate and timely processing of medical, dental, vision and prescription drug claims. • Provide courteous and prompt responses to customer inquiries. • Communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public. • Verifies the accuracy and receipt of all required documentation for each claim submitted. • Collaborates with providers, plan participants, other claims payers, or any other party necessary to obtain information necessary to accurately process a claim. • Analyzes information necessary for processing. • Assures that the system processes the claim correctly and determines payment according to the plan as written. • Answers telephone calls from plan participants, group contacts, and customer service representatives pertaining to benefits and claims inquiries. • Resolves problematic claims with the assistance of the Team Leader, Claims Manager and/or the Director of Claims. • Assigns critically ill patients to large case management. • Assists other examiners as needed due to workload requirements, including assigned back-up when examiners are absent. • Aids the Team Leader and/or the Claims Manager in the resolution of claim appeals and disputes by providing documentation for review. • Researches, calculates and requests refunds when necessary. • Contributes to the daily workflow with regular and punctual attendance. • Thoroughly researches and completes renewal reports in a timely manner in consultation with the Marketing Department. • Process eligible claims on groups before the end of their stoploss contract renewal period. • Assists the Legal Department with subrogation claims as necessary. • Attends various group meetings as required. • Assists with audits as needed. • Assists with plan benefit set-up and changes as needed.

Job Requirements

  • High school graduation or GED required.
  • Basic computer and customer service experience required.
  • Excellent oral and written communication skills required.
  • PC skills, including Windows and Word.
  • Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication.
  • Typing ability of 45 wpm net
  • Excellent listening skills.
  • Basic mathematical skills.
  • High level of interpersonal skills to work effectively with others.
  • Ability to organize and recall large amounts of detailed information.
  • Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
  • Ability to meet productivity standards with 99% financial accuracy and 95% procedural accuracy.
  • Thorough knowledge of claims processing procedures and requirements.
  • Ability to project a professional image and positive attitude in any work environment.
  • Ability to comply with privacy and confidentiality standards.
  • Ability to be flexible, work under pressure and meet deadlines.
  • Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
  • Ability to operate typical office equipment.
  • Working knowledge of general office procedures.

Benefits

  • Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

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