4 Remote Claims jobs in the United States
Claims Representative - Remote
Posted 23 days ago
Job Viewed
Job Description
SUMMARY
The claims representative is responsible for manually reviewing and processing medical, supplemental, or dental claims. Claims are processed according to benefits, eligibility, and internal processes, policies, and procedures and may be completed, held for additional information/review, or denied. New claim representatives will be provided with a robust training program, which includes virtual classroom training, on-the-job learning/feedback, and gradually increasing claims per hour/quality requirements over several months. After completion of training, claim representatives must meet specific accuracy/quality, volume/claims per hour, and on production performance metrics.
$19/Hour Pay Rate
RESPONSIBILITIES
• Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines.
• Confirm the presence of necessary documents within submitted claims.
• Validate the accuracy of medical codes provided in claim submissions.
• Assess the eligibility status of claims based on established criteria.
• Review and verify other insurance coverage information in submitted claim.
• Evaluate authorizations provided in claim submissions for accuracy.
• Analyze account benefit plans to ensure claims align with coverage and policies.
• Identify discrepancies, errors, or missing information.
• Utilize multiple computer applications simultaneously.
• Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision.
• Meet or exceed quality and productivity goals.
• Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows.
• Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors.
QUALIFICATIONS
• High school diploma or equivalent
• Ability to quickly learn a variety of computer applications to complete job functions ,
• Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook .
• Knowledge of basic Microsoft Excel functions, such as filtering/sorting.
• Experience in navigating multiple computer applications through the use of shortcut keys and other techniques.
• Detail-oriented with experience in applying complex policy/procedure documents.
• Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines.
• Proven experience completing work with quality and productivity performance standards.
• Experience working independently in a virtual environment preferred.
• Experience with medical and insurance terminology in a professional setting preferred.
• Knowledge of CPT/ICD-10 codes preferred.
• Proven experience in health insurance claims processing or similar field 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 17.75 - 25 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: for support. Do not email 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.
Claims Systems Intake Analyst - EviCore - Remote
Posted 2 days ago
Job Viewed
Job Description
We're seeking a proactive Intake Analyst to support our growing team focused on process improvement and production support. This role is critical to managing incoming business requests, assessing stakeholder needs, and prioritizing work. The ideal candidate is detail-oriented, collaborative, and passionate about driving operational excellence.
Key Responsibilities
- Serve as the first point of contact for business-side intake requests
- Facilitate stakeholder requirement gathering and documentation
- Collaborate with the Product and Planning team to transition qualified requests for agile delivery
- Maintain intake tracking and metrics in Smartsheet
- Identify trends and recommend process improvements to reduce turnaround time
Qualifications
- High School Diploma or equivalent required
- 4 plus years of experience in business analysis, intake coordination, or operations required
- Strong communication and stakeholder engagement skills preferred
- Familiarity with Smartsheet, Jira, and/or similar tools preferred
- Experience with EOM or agile frameworks preferred
- Ability to manage multiple priorities in a fast-paced environment 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.
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: for support. Do not email 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.
Business Project Analyst Claims Systems - EviCore - Remote
Posted 2 days ago
Job Viewed
Job Description
Work can range in content including (but not limited to) Root cause analysis of systemic issues that impact claims processing, performance management, or process improvement. A fundamental understanding of claims processing, configuration, and adjudication is required for success in this role.
Job Components and Deliverables
PROGRAM MANAGEMENT:
- Production Support - Monitor controls and Identify issues; root cause analysis, solutioning, document and maintain log of issues
- Project Support - Develop and manage detailed business requirements using a combination of stakeholder input and subject matter expertise, document validation requirements (including use case definition, expected results, defect logging, validation and governance of process)
DRIVING SOLUTIONS:
- Root Cause Analysis -analyze data, system workflows, requirements and feeds to determine issue cause and appropriate solutioning suggestions
- Facilitation - lead and document idea sessions around problem resolution to address business needs
- Process - follow portfolio and production processes to resolve issues and identify project needs. Including but not limited to Intake creation, project request forms and collaterals, business case support, status reporting updates, communications surrounding issues and fixes, and governance support (logs, materials, decision support)
COMMUNICATION:
- Sponsorship / Senior Level - Concise, effective communication around progress, risks, timing and decisions needed at the senior level
- Team - Detailed plans and activities to identify timing and ownership.
- Organizational - Clear, effective communication to matrix partners on timing / impact of implementations on their departments.
Cigna Core Competencies
ALIGN:
- Manages Complexity - Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems
- Manages Conflict - Handling conflict situations effectively, with a minimum of noise - applying knowledge of business and the marketplace to advance the organization's goals
- Collaborates - Building partnerships and working collaboratively with others to meet shared objectives.
INSPIRE:
- Communicates Effectively - developing and delivering multi-modal communications that deliver a clear understanding of the unique needs to different audiences
- Persuades - Use compelling arguments to gain the support and commitment of others
DEVELOP:
- Nimble Learning - Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.
- Situational Adaptability - Adapting approach and demeanor in real time to match the shifting demands of different situations
- Tech Savvy - Anticipating andadoptinginnovationsinbusiness-buildingdigitalandtechnologyapplications.
DELIVER:
- Drives Results - holding self accountable to meet commitments
- Action-Oriented - consistently achieving results, even under tough circumstances
- Optimizes Work Processes - Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement.
BASIC QUALIFICATIONS:
- High School Diploma or GED required
- 3+ years of experience with claims adjudication engines (CAE) required (ex: Facets, QNXT, HRP)
- Experience with documenting business requirements for configurations and adjudication rules
- 3+ years of Business Analysis, Agile product support, Project Management, or applicable experience, required
- Agile / Traditional requirements development / delivery methodology awareness
- Demonstrated experience and mastery in skills listed above
- Working knowledge of EviCore operations, systems, and client data
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 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: for support. Do not email 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.
Provider Relations & Claims Advocate - Evernorth Behavioral Health - Remote
Posted 20 days ago
Job Viewed
Job Description
Note: This position requires a Bachelor's degree to qualify.
Key Responsibilities:
- Answer inbound calls from members and providers regarding claims, contracting, and provider relations.
- Work in a structured call queue environment, handling a high volume of calls daily.
- Make outbound calls as needed for issue resolution or follow-up.
- Use multiple applications during calls to research and resolve inquiries.
Call topics may include:
- Claim status inquiries and explanations
- Requests for claim reprocessing or adjustments
- Provider contract questions and demographic updates
- Authorization corrections to ensure proper claim payment
- Requests for duplicate EOBs or check reissuance
- Escalated issue handling via Advocate Handoff/Help Request (AHHR)
- Complaint submissions on behalf of members or providers
- Emailing resources and documentation to callers
- Proven customer service experience
- Prior experience in Evernorth Behavioral Care Specialist/Advocacy role preferred
- Experience handling behavioral health claims and provider relations calls is a plus
- Ability to thrive in a virtual team environment
- Strong interpersonal and communication skills
- Effective listening and organizational abilities
- Technical aptitude with multiple systems and applications
- Independent problem-solving and time management skills
- Proficient typing and PC skills
- Monday through Friday, 8:30 AM - 5:00 PM CT
- After training, shifts are Monday through Friday between 7:00 AM - 7:00 PM CT
- The recruiter will provide specific shift options
- Bachelor's degree is required
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 24 - 36 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 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: for support. Do not email 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.
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