Claims Representative - Remote

Entry-Level Dental Claims Representative - Job Description

SUMMARY
The Dental Claims Representative is responsible for reviewing and processing dental claims in accordance with plan benefits, eligibility, and internal policies.

This entry-level role is ideal for individuals beginning their career in healthcare operations, offering hands-on experience in dental claims processing and exposure to industry-standard tools and practices.

Representatives will be trained to accurately adjudicate claims, identify discrepancies, and ensure timely resolution.

Success in this role is measured by accuracy, productivity, and a commitment to learning and development.

RESPONSIBILITIES


* Review and process dental claims using established procedures and guidelines.


* Verify member eligibility and plan benefits to determine appropriate claim outcomes.


* Accurately enter and update claim information in the system.


* Identify and flag claims requiring additional documentation or review.


* Collaborate with team members and supervisors to resolve claim issues.


* Participate in training sessions and team meetings to build knowledge and skills.


* Utilize virtual tools such as Outlook, Webex, and internal platforms to communicate and stay connected with team members and leadership.


* Maintain confidentiality and adhere to HIPAA and other regulatory requirements.

QUALIFICATIONS


* High school diploma or equivalent required; associate's or bachelor's degree preferred.


* Strong attention to detail and a willingness to learn.


* Basic understanding of dental terminology and/or RDA/RDH is a plus, but not required.


* Proficient in Microsoft Office applications, especially Outlook and Excel.


* Strong written and verbal communication skills.


* Ability to work in a fast-paced, deadline-driven environment.


* Excellent organizational and time management skills.


* Customer service or administrative experience in a healthcare or dental setting is a plus.

GROWTH OPPORTUNITIES


* This role offers a clear path for advancement into more specialized or senior claims roles, including opportunities to:



* Support cross-functional projects.


* Train as a subject matter expert (SME).


* Participate in quality improvement initiatives.


* Gain exposure to multiple claims platforms and processes.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives.

At The Cigna Group, we're dedicated to improving the health and vitality of those we serve.

Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients.

Join us in driving growth an...