Claims Lead Representative

4 weeks ago

Remote, Oregon, United States The Cigna Group Full time
The job profile for this position is Claims Lead Representative, which is a Band 2 Professional Career Track Role.

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Claims Lead Representative for Cigna LifeSOURCE (aka NAC Claims Repricer)

Role Summary: Examines and reprices paper and electronic claims for Network Access Client (NAC) business for the Cigna LifeSOURCE Transplant Network. Determines steps necessary for repricing. Ability to understand and apply LifeSOURCE contract terms and rates, as well as individual Letters of Agreements, to claims and reprice accurately. Preferably 5 years experience in claims processing. Responsible for independently reviewing complex, specialty claims. Works closely with LifeSOURCE Transplant Care Coordinators (nurses).

Responsibilities:

  • Reprice claims for growing NAC business for Cigna LifeSOURCE network meeting turnaround times of 5 business days, 95% procedural accuracy and 98.5% financial accuracy
  • Be able to understand and apply the various provisions and rates from 160+ LifeSOURCE contracts
  • Determine if claims are transplant or non-transplant related, appropriate zone and apply correct rates from LifeSOURCE contract
  • Research and review claims issues, working with providers, payers, contracting team and NAC nurse coordinators to resolve
  • Participate on conference calls as needed for any escalated issues
  • Work closely with LifeSOURCE nurse coordinators to determine zones as well as transplant related and non-transplant related claims
  • Respond to telephonic and e-mail claims inquiries from clients and providers
  • Provide support, as needed, to other teams within Payer Solutions including medical/dental claim pricing, correspondence, etc.
  • Other duties as assigned

Qualifications:

  • 3+ years experience in claims processing and adjudication with experience in inpatient, outpatient hospital and professional claims
  • Transplant claims experience a plus
  • Strong verbal and written communication skills
  • Working knowledge of Excel
  • Strong analytical and problem solving skills
  • Highly motivated, self-starter with ability to work independently and as a team to achieve goals and objectives
  • Ability to work with providers, contracting, account managers, nurse coordinators and clients to resolve claims issues
  • Ability to understand transplant provider contracts, interpret contract language and rate provisions

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 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.

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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

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