**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**
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 and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_
[email protected]_ _for support. Do not email_
[email protected]_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._