Tennessee, Alabama, Arizona, Georgia, Oklahoma,Pennsylvania, Texas,PA, Tenn, AZ
Egg Harbor, New Jersey, King of Prussia, Pennsylvania, Piscataway, New Jersey,
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being, and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas, and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
Customer Service & Claims Fully remote
Here’s a little more about what you’ll do:
Help clients, customers, and health care providers understand our business a little better. Topics like determination of payments and claims related to medical and dental procedures and office and hospital visit costs are common questions.
Make it easy for customers to work with us. Take ownership of their issues and do your best to resolve them over the phone the first time, every time.
Be an advocate for health and wellness. Educate customers on disease management programs and make recommendations on the right healthy living programs for their needs.
Enjoy regular development opportunities and mentorship as you train with the best team in the industry. We offer extensive, hands-on training and guided on-the-job training to ensure you’re successful here. (And enjoy your job too!)
What you should have:
Must be willing to work a designated shift between 7 am - 7 pm, Monday through Friday
High School Diploma or equivalent required, Associates or Bachelor’s degree preferred
1+ years of customer service experience analyzing and solving customer problems required;
Intermediate proficiency in Microsoft Office Suite; high-level capacity to multitask independently and on a computer
Knowledge of Medical Terminology a PLUS
Excellent written and oral communication skills
Exceptional organizational and time-management focus
This position is not eligible to be performed in Colorado.
Primary Job Responsibilities
Test and maintain new and existing automated processes.
Responsible for researching and resolving outcome report exceptions in a timely.
Manage inventory for automation processes to ensure all required items are being worked on and included in the workflow daily.
Maintain automation VDI (Virtual Desktop) library to include requesting new machines, and updating access as required for lower (RLSE 1, RLSE2, SYST, etc.) and production VDI’s.
Groom relevant user stores for new processes, enhancements, and maintenance requirements.
Responsible for gathering and analyzing data in an accurate and timely manner.
Ability to handle potentially stressful situations and multiple tasks simultaneously.
Works independently and takes the initiative in completing work assignments and other project work.
Demonstrates Customer-Centric attributes and associated behaviors to deliver exceptional customer experiences
Provides a superior level of professionalism and knowledge when communicating with internal matrix partners and external customers
Embraces the virtual work environment through active participation in virtual team huddles, Barrier Time Conversations and monthly 1x1’s, usage of the virtual tools including but not limited to, Lync, email, web ex, . Readily identifies any virtual barrier to their supervisor.
Participates in operational meetings and training sessions as necessary
Ensure privacy and confidentiality as required by HIPAA, company, and departmental guidelines.
Other special projects and tasks as assigned.
Egg Harbor, New Jersey, King of Prussia, Pennsylvania, Piscataway, New Jersey,
Independently investigates, evaluates, and resolves assigned medical only and lost time Workers’ Compensation claims in a timely manner in accordance with legal statutes, policy provisions and company guidelines.
Evaluate injured worker eligibility; communicate with attending physician, nurse case manager, employer and injured worker.
Work with both the injured worker and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information.
Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis.
Work directly with manager and assistant manager to make compensability decisions, monitor injured worker’s progress, and pay lost time and medical benefits.
Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
Identify potential for disability or pension credits or offsets and apply same where appropriate.
Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.
Close all files as appropriate in a timely and complete manner.
Maintain closing ratio as directed by the management team.
Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees’ medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
Complete PARs (payment authorization request) and FOCUS reports when applicable.
Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting.
Communicate effectively, verbally, and in writing with internal and external parties on a wide variety of claims and account-related issues.
Provide a high degree of customer service to clients, including face-to-face interactions during claim reviews, meetings, and similar account-specific sessions.
Perform other duties as required.
Education and Experience:
High School diploma required;
Associate’s or Bachelor’s degree preferred, or five or more years of equivalent work experience required in insurance, medical/health or legal related industry;
At least 2 years of experience handling lost time workers’ compensation claims are required; more experience may be required depending upon the complexity of the claim pending.
Completion of Workers’ Compensation training courses internally and/or externally in all significant areas affecting Workers’ Compensation claims handling and practices a plus
Workers’ Compensation licenses, certifications, awards preferred.
Piscataway, New Jersey,Egg Harbor, New Jersey,
POSITION SUMMARY
The Technical Assistant position provides support to the Worker's Comp Claims Adjusting team.
Location: This role is onsite in either the Piscataway, NJ or Egg Harbor Twp, NJ office (there may be an opportunity to work at home 1-2 days a week)
Schedule: Monday -Friday, regular business hours
KEY RESPONSIBILITIES:
Assist in the opening, stamping, indexing, and scanning of incoming mail; input drafts and vouchers; photocopy and pay medical bills related to the claims.
Setting up new claims, entering notes in claims software system
Code bills for proper payment
Delivery of faxes via email.
Answer phones and take messages; provide customer service support to adjusters.
File files and paperwork; pull files; organize files for audits, printing comments.
Assist Adjusters with clerical tasks such as photocopying, certified and overnight mailings, return calls to clients and providers to obtain missing information and for follow-up.
Work with our intake department to monitor SLA to ensure members are receiving claim acknowledgment
Look up new claims in the system to ensure accuracy and completion.
Job Description
Do you enjoy helping people? Do you thrive in a fast-paced, customer-focused environment? Then start your rewarding career as a part of our growing Customer Service team! Cigna is one of the largest and fastest-growing health insurers in the world. As a Customer Service Associate, you will help and work with customers and members to improve their health, well-being, and sense of security. At Cigna, we invest in you. As a Customer Service Advocate, you are offered extensive, paid hands-on training, a supportive post-training environment to pave your success. Cigna encourages career development and offers continuing educational resources internally and externally to help you in your career advancement. Role Summary In this pivotal role, Customer Service Advocate responds to complex inquiries regarding benefits, billing, eligibility, coverage and other related information and provide solutions for customers, clients and health care professional via phone and email. Creative problem solving, critical thinking, and empathy skills are essential. Professional interaction, active and passive listening skills and the ability to utilize computer-based resources in a highly effective manner to educate and provide accurate responses to customer inquiries is crucial for success in the role, along with the innate ability to be compassionate and empathetic when appropriate when handling complex customer inquiries.
ESSENTIAL FUNCTIONS
Use of pharmacy and scheduling programs for the documentation and nurse scheduling of home infusion visits.
Proactively communicate to field staff, nurse management, and patients.
Investigate/research issues and provide resolution.
Take initiative for problem-solving with the ability to multitask effectively and use critical thinking.
Correct and timely entry of data in appropriate systems.
A pro-active work ethic with the ability to be managed/trained virtually
Proficiency and use of Excel and Outlook
QUALIFICATIONS
High School education or GED.
3+ years of relevant Customer Service experience.
Microsoft Office Suite.
Extremely detailed oriented.
Excellent written and oral professional communication skills.
Ability to adapt in a dynamic work environment, learn quickly, solve problems, and make independent decisions.
Customer Service Representative. Our Customer Service Representatives have dedicated team members who excel at customer service, helping us elevate our Patient Care to new heights. In this crucial role, you are on the front lines with patients, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.
Here’s a little more on how you’ll make a difference:
Help patients understand their pharmacy benefits better. Use the knowledge you gain from training, your problem-solving skills, and support from your team to answer patient calls effectively.
Help us keep track of our patient interactions. While on calls, use your expert listening skills to get to the heart of a patient’s question quickly and document all interactions in real-time.
Ensure patients are equipped with the best advice. Identify and empathetically address patient concerns and, if necessary, escalate appropriately.
What You Should Have:
High School Diploma / GED required
1 year of relevant experience
General PC knowledge including Microsoft Office
Excellent communication skills (verbal and written)
What you’ll love about working here:
******** $2000.00 Sign On Bonus**************
Fun, friendly, and unique culture – Bring your whole self to work every day!
Medical Dental & Vision start 1st day
18 days Paid Time Off & 8 Paid Holidays
Employer Contributions for HRA and HSA accounts
401K with Company Match
Tuition Assistance
******Partial payment after 45 days, 90 days, and 9 months of employment*********
.
Customer Service Advocate responds to the customer, health care professional and client inquiries primarily regarding:
Eligibility to receive benefits associated with their individual or company-sponsored health insurance plan
Determination of pocket costs related to medical or dental office visits, prescription medications, inpatient and outpatient procedures, diagnostic imaging for treatment of injuries, medical equipment, and preventive care
Understanding of payments and claims related to office and hospital visits and medical and dental procedures, and thoroughly explaining how customer benefits are applied to costs associated with these visits and procedures
Finding in-network primary care or specialist doctor in a geographical area or specialty
Education on disease management programs and healthy living programs personalized to the customer’s medical condition or health improvement goals.
Customer Service Advocates are measured on:
Direct feedback from customer and health care professionals via post-call surveys, which include:
The ability of the customer service associate to resolve their inquiry
Their satisfaction with the overall experience while they spoke with the associate
The level of effort that the customer experienced in resolving their inquiry
Internal quality assessments that measure how accurately and efficiently the customer service associate responded to the inquiry
Does this sound like you?
Customer Focused – a genuine desire to help people
Problem solver – understand issues and enjoy solving them
Active listener, with the ability to provide confident responses
Effective use of tools – including knowledge management tools and resources
Able to manage real-time inquiries while keeping track of and responding to commitments to follow-up with customer inquiries
Collaborator – enjoys working with co-workers across different functional areas
Professional and tactful – able to respond to and calm a situation
Able to offer options and educate customers when appropriate.
Tennessee, Alabama, Arizona, Georgia, Oklahoma, Pennsylvania, Texas,PA
Claims Representatives
Help our customers maintain their health, well-being, and sense of security by ensuring medical claims are processed accurately and timely while protecting the confidentiality of our customer’s personal health information. Under direct supervision performs duties relating to the claims adjudication process from review of the claim form, verification of eligibility, verification of coordination of benefits with insurance carriers, and finalization based on the health benefits plan. Technical advice and assistance will be provided by Technical Coaches.
Responsibilities
Review claim submissions to confirm required documents have been received, verify medical codes, eligibility, other insurance, authorizations, and account benefit plans.
Follows established policies and procedures to pay, pend for additional information, or deny claims.
Adapt to and positively influence change by accepting feedback with a growth mindset to continuously improve.
Follow processes and work independently to meet or exceed Key Performance Indicators (KPI)
Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1x1 or check-ins, using a variety of virtual tools, i.e. Outlook email, Skype for Business, Cisco Web-Ex, or other similar applications.
Maintains a high level of accuracy in all duties performed.
Team members will be held accountable for meeting and maintaining minimum quality and production standards through the use of Management Operating Systems (MOS) tools: Daily Production Log (DPL), Performance Profile, Claim Review tool, and other reporting systems.
Partner with the Resource Management Group (RMG) on Workflow Tool (WFT), pended claims, or other inventory issues.
Partner with Technical Coaches to understand claim processes and procedures.
Our Patient Care Advocates have dedicated team members who excel at customer service, helping us elevate our patient care to new heights. In this crucial role, you are on the front lines with patients, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy. Here’s a little more on how you’ll make a difference: • Help patients understand their pharmacy benefits better. Use the knowledge you gain from training, your problem-solving skills, and support from your team to answer patient calls effectively. • Help us keep track of our patient interactions. While on calls, use your expert listening skills to get to the heart of a patient’s question quickly and document all interactions in real-time. • Ensure patients are equipped with the best advice. Identify and empathetically address patient concerns and, if necessary, escalate appropriately.
What you’ll love about working here:
$2000 Sign-On Bonus*
Fun, friendly, and unique culture – Bring your whole self to work every day!
Choice of three unique medical plans
Prescription Drug, Dental, Vision and Life Insurance
Employee Contributions for HRA and HSA accounts
401K with Company Match
Paid Time Off and Paid Holidays
Tuition Assistance
*Partial payment after 45 days, 90 days, and 9 months of employment. What You Should Have: • High School Diploma / GED required • 1 year of relevant experience • General PC knowledge including Microsoft Office • Excellent communication skills (verbal and written) What you’ll love about working here: • Fun, friendly, and unique culture – Bring your whole self to work every day! • Choice of three unique medical plans • Prescription Drug, Dental, Vision and Life Insurance • Employee Contributions for HRA and HSA accounts • 401K with Company Match • Paid Time Off and Paid Holidays • Tuition Assistance
Care Advocate.
Our Patient Care Advocates have dedicated team members who excel at customer service, helping us elevate our patient care to new heights. In this crucial role, you are on the front lines with patients, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.
Here’s a little more on how you’ll make a difference:
Help patients understand their pharmacy benefits better. Use the knowledge you gain from training, your problem-solving skills, and support from your team to answer patient calls effectively.
Help us keep track of our patient interactions. While on calls, use your expert listening skills to get to the heart of a patient’s question quickly and document all interactions in real-time.
Ensure patients are equipped with the best advice. Identify and empathetically address patient concerns and, if necessary, escalate appropriately. What You Should Have:
High School Diploma / GED required
1 year of relevant experience
General PC knowledge including Microsoft Office
Excellent communication skills (verbal and written) What you’ll love about working here:
Fun, friendly, and unique culture – Bring your whole self to work every day!
Choice of three unique medical plans
Prescription Drug, Dental, Vision and Life Insurance
Employee Contributions for HRA and HSA accounts
401K with Company Match
Paid Time Off and Paid Holidays
Tuition Assistance
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