As a Claims Senior Representative you would be responsible for processing overpayments in the refund and recovery department.

This is a great opportunity to learn a lot about the financial aspects of claims repayments and offers opportunities for personal and professional growth.

How you'll make a difference in this role:

• Responsible for the review, research, evaluation, and applying provider refund checks to overpaid professional and facility claims which may require reprocessing CMS 1500 as well as UB's


• Compares claim application and/or provider statements with policy file and other records to evaluate completeness and validity of claim and refund


• Performs claim research and investigation for proper resolution


• Utilizes expertise to appropriately apply claim concepts, rules and departmental practices, ensuring accuracy, and timeliness of provider refunds


• Confirm member eligibility and claim pricing


• Display initiative and ability to work independently on investigation and research of claim inquiries


• Refer questionable provider refund checks appropriately for escalation


• Concisely and professionally reply to claim inquiries and provider refund check from internal and external business partners


• Comply with department policies, procedures and goals


• Deliver specific delegated Claims tasks assigned by a supervisor


• Examine and process paper claims and/or electronic claims; Determines whether to return, pend, deny or apply provider refund to claims


• Follows established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues as well as settles claims with claimants in accordance with policy provisions


• Successfully work in an independent environment

Qualifications:

• High School Diploma or GED


• 2+ years of experience in medical claims processing or related field


• Data entry skills including 10 key preferred


• Excellent customer centric and analytical skills


• Possess strong written and oral communication skills when interacting with team members and management


• Comfortable with working and navigating in multiple systems to include applicable CMS Websites


• Experience using QNXT, APPX, Etracks, Zelis, Sharepoint, and Excel preferred


• Medical Terminology and Coding


• Ability to price professional or facility claims

This position is onsite, in the Nashville office, and is expected to primarily have a schedule within normal business hours, Monday - Friday, or as business needs dictate.

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 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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.