Job Description

Want to Drive Growth and Improve Lives? EviCore a division of The Cigna Group is hiring a Claims Examiner - 1. For this integral role you\'ll be responsible for the review, evaluation, research, correction and processing of medical claims.

How you\'ll make a difference:

Applies proper claim concepts, rules and practices, ensuring accuracy and timeliness of claims payment through demonstrated knowledge of medical terminology, health insurance plans and medical billing concepts

Utilize expertise to appropriately apply claim concepts, rules and departmental practices, ensuring accuracy, and timeliness of claims payment

Confirm member eligibility, claim pricing and verify authorization and service appropriateness.

Follow appropriate workflows to confirm necessary information such as member eligibility and claim pricing

Display initiative and ability to work independently on investigation and research of claim inquiries and refer questionable claims appropriately for escalation

Possess strong written and oral communication skills to concisely and professionally reply to claim inquiries from internal and external business partners

What you need to succeed:

High School diploma or GED required

1+ years of experience in medical claims processing required

1+ years of experience with eviCore delegated plans with working knowledge of horizon Health plan preferred

Proficiency in Microsoft products such as Outlook, Excel, Word required

Experience with Plexus Claims Management (PCM), Truist and Cigna Portal preferred

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 - 22 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\xe2\x80\x99s why you\xe2\x80\x99ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you\xe2\x80\x99ll 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 .

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.

Cigna