Claims Representative

JOB OPPORTUNITY WITH CIGNA HEALTHCARE Position: Claims Representative Employer: The Cigna Group THE ROLE Join The Cigna Group's insurance team as a Claims Representative and become a vital part of our healthcare operations. In this position, you will manage the complete claims lifecycle for medical insurance customers. Your day-to-day responsibilities will include reviewing and validating medical claims documentation, verifying patient and policy information for accuracy and completeness, and determining coverage eligibility based on policy guidelines. You will calculate claim amounts, process payments to healthcare providers, and maintain organized records within our database systems. Additionally, you will respond to inquiries from agents, beneficiaries, and healthcare providers regarding coverage details and claims status. Success in this role demands meticulous attention to detail, strong organizational capabilities, and the ability to remain calm and productive under tight deadlines. You will need excellent communication skills to effectively liaise with medical offices, insurance partners, and clients when addressing claim-related issues. KEY RESPONSIBILITIES • Validate and thoroughly review all incoming medical claims to identify and address missing or incomplete information before processing • Maintain accurate, detailed records of all claims and follow up on cases that remain unresolved • Demonstrate comprehensive knowledge of medical terminology, CPT codes, and ICD-9 codes in your daily work • Enter and maintain insurance policy and claims data accurately within our database management system • Assess policy coverage parameters and calculate appropriate claim payment amounts • Process claim payments and ensure timely disbursement to providers • Address customer questions regarding policy coverage, eligibility criteria, and claims procedures • Review and interpret medical documentation to make accurate claim approval or denial decisions • Adhere to all federal, state, and company regulations and policies governing insurance operations • Perform additional clerical and administrative tasks as needed to support team operations WHAT WE'RE LOOKING FOR • Minimum two years of professional experience working as a claims processor or in a closely related insurance role • Solid understanding of medical terminology, CPT coding systems, and ICD-9 classification codes • Working knowledge of the insurance industry, including relevant federal and state regulatory requirements • Proficiency with computer systems and Microsoft Office applications • Strong critical thinking and analytical decision-making abilities • Excellent organizational and administrative skills • Outstanding customer service orientation and interpersonal abilities • Capability to manage multiple priorities and perform effectively under pressure • Exceptional attention to detail and accuracy in all work performed • Medical background or healthcare training (preferred advantage) ABOUT CIGNA HEALTHCARE Cigna Healthcare, a division of The Cigna Group, champions better health across every life stage. We support our customers in navigating the healthcare system by providing the knowledge and resources they need to make informed decisions about their wellbeing. We invite you to contribute to our mission of growth and improved quality of life for those we serve. EQUAL OPPORTUNITY The Cigna Group considers all qualified applicants regardless of race, color, age, disability, sex, pregnancy and related medical conditions, lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or family status, genetic information, public assistance status, citizenship status, or any other characteristic protected by applicable employment laws. If you need reasonable accommodations to complete the application, please contact SeeYourselfEMEA@cigna.com for assistance. Please note this email address is for accommodation requests only and cannot provide application status updates or accept resumes.