Claims Representative

Main Duties / Responsibilities

• Validate information on all medical claims from patients seeking payment from the company.
• Review claims thoroughly to ensure there is no missing or incomplete information.
• Keep meticulous records of claims and follow up on lapsed cases.
• Record and maintain insurance policy and claims information in a database system.
• Determine policy coverage and calculate claim amounts.
• Process claims payments.
• Answer queries related to policy coverage criteria and guidelines.
• Comply with federal, state, and company regulations and policies.
• Read and assess medical documents to approve or deny payment to doctors.
• Communicate with doctors' offices or insurance companies to resolve problems with claims.
• Perform other clerical tasks as required.

Requirements & Qualifications

• A medical-related Diploma or Degree qualification is required.
• At least 1 year of experience as a medical claims processor.
• Extensive knowledge of medical terminology and experience using a computer.
• Familiarity with medical terminologies and understanding of CPT codes and ICD-9 codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details.

How to Apply

Interested and qualified candidates should apply online via the Cigna recruitment portal at cigna.wd5.myworkdayjobs.com.