Job Description
The job profile for this position is Claims Associate Representative, which is a Band 1 Professional Career Track Role.
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
Cigna – Claims Processor
The Position:
We are looking for a detail-oriented claims processor to join our insurance team. The role of a claims processor is to enter and adjudicate medical claims on a daily basis ensuring data integrity in the system. You will be responsible for processing member and provider claims of all regions withing the standard turn-around time, verifying information, and corresponding with hospitals and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.
To be successful as a claim’s processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.
Main Duties / Responsibilities • A medical claims processor should adjudicate the claims in line with the policy coverage and medical necessity and validates the information on all medical claims from member and providers seeking payment. • Claims must be thoroughly reviewed to ensure that there is no missing or incomplete medical information. • Able to accurately assess medical eligibility within the guidelines and give evidence-based advice on claims, considering internationally accepted protocols and local and/or regional customs and regulations. • Should have the ability to review, investigate and respond to external and internal inquiries/complaints and provide guidance to others related to medical necessity. • a processor must keep meticulous records of claims and follow up on lapsed cases. • Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claims payments.
• Answering queries related to Policy coverage criteria and guidelines.
• Complying with federal, state, and company regulations and policies. • Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents. • Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim. • Achieving required targets assigned on daily, weekly and monthly basis.
• Performing other clerical tasks, as required.
Claims Processor Requirements:
• Medical, paramedical Qualification Background with healthcare experience.
• At least 2 years of experience as a medical claim’s processor or in a related role.
• Knowledge of Medical Terminologies, CPT codes and ICD-+ codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
Cigna – Claims Processor
The Position:
We are looking for a detail-oriented claims processor to join our insurance team. The role of a claims processor is to enter and adjudicate medical claims on a daily basis ensuring data integrity in the system. You will be responsible for processing member and provider claims of all regions withing the standard turn-around time, verifying information, and corresponding with hospitals and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.
To be successful as a claim’s processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.
Main Duties / Responsibilities • A medical claims processor should adjudicate the claims in line with the policy coverage and medical necessity and validates the information on all medical claims from member and providers seeking payment. • Claims must be thoroughly reviewed to ensure that there is no missing or incomplete medical information. • Able to accurately assess medical eligibility within the guidelines and give evidence-based advice on claims, considering internationally accepted protocols and local and/or regional customs and regulations. • Should have the ability to review, investigate and respond to external and internal inquiries/complaints and provide guidance to others related to medical necessity. • a processor must keep meticulous records of claims and follow up on lapsed cases. • Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claims payments.
• Answering queries related to Policy coverage criteria and guidelines.
• Complying with federal, state, and company regulations and policies. • Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents. • Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim. • Achieving required targets assigned on daily, weekly and monthly basis.
• Performing other clerical tasks, as required.
Claims Processor Requirements:
• Medical, paramedical Qualification Background with healthcare experience.
• At least 2 years of experience as a medical claim’s processor or in a related role.
• Knowledge of Medical Terminologies, CPT codes and ICD-+ codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
💡 Quick Summary
Seeking a career-building opportunity? The Claims Associate Representative position is now open for candidates interested in the Health Jobs sector. This role in Noida offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Health Jobs is a plus.