Job description

eviCore is currently hiring a Claims Representative. The Claims Representative processes claims submitted by pharmacies and other healthcare agencies. Work with internal departments to resolve claim issues. Helps to identify repetitive problems or questions in order to pursue process or procedural changes. Assists other internal departments as needed to ensure high quality/timely work.

SHIFT: Monday - Friday 8a-5p EST (There is some flexibility for those living in other time zones.)

RESPONSIBILITIES:
Navigate through appropriate system platforms.

Evaluate claim submission, ensure all required information is present and determine what action should be taken to adjudicate claims within client specific turnaround times.

Identify repricing issues in production and escalate to leadership.

Help to identify and escalate repetitive problems.

Identify exception handling and process per client requirements.

Take calls on claim inquiries.

Maintain scheduled adherence.

Maintain an average of 20 claims per hour (cph).

Assist with other teams as needed to ensure overall MDM success.

QUALIFICATIONS:
High School Diploma or equivalent.
2-3 years of claims operational experience preferred
Familiarity with ESI adjudication platforms preferred
Customer service experience preferred
Strong data entry
Strong attention to detail
Ability to problem solve
Proficient written and oral communication skills
Strong customer focus
Must be a self - starter and team player
Ability to adapt in a dynamic work environment, learn quickly, solve problems and make decisions with minimal supervision.

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 - 24 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: 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.

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