Claims Representative - Evernorth - Remote

SUMMARY

Claims Representative

The FACETS claims representative is responsible for manually reviewing and processing healthcare claims using the FACETS platform.

Claims are processed according to benefits, eligibility, and internal processes, policies, and procedures and may be completed, held for additional information/review, or denied.

This role ensures compliance with company policies, regulatory requirements, and confidentiality standards while delivering exceptional service to providers and policyholders.

$19/Hour Pay Rate

RESPONSIBILITIES

• You will use the FACETS claim processing tool to review basic claim submissions and confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.

• You will determine appropriate action: pend, deny, or pay claims in accordance with policy provisions and regulatory guidelines.

• Follow processes and work independently to meet or exceed Key Performance Indicators (KPIs) for accuracy, timeliness, and productivity.

• Adapt to system updates and process changes, contributing to continuous improvement initiatives.

• Maintain strict confidentiality of customer health information in compliance with HIPAA and company standards.

QUALIFICATIONS


* Education: High School diploma or GED required


* Experience: Experience in insurance concepts, medical claims processing and adjudication preferred


* Technical: Computer proficiency and ability to learn new systems quickly.


* Excellent verbal and written communication skills.


* Ability to work independently and meet production and quality standards.


* Strong analytical and problem-solving skills


* Ability to manage multiple priorities in a fast-paced environment


* Demonstrated commitment to meeting the expectations of internal and external customers

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.

For this position, we anticipate offering an hourly rate of 17.75 - 25 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure.

That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.

We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

For more details on our employee benefits programs, visit Life at Cigna Group .

About The Cigna Group

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