Claims Representative - Evernorth - Remote (St. Louis, MO)

Claims Processor

This position entails processing of direct member and pharmacy submitted claims timely and accurately. Validate member's eligibility and ensure claim information entered is complete and accurate. Process claims according to client specific guidelines while identifying claims requiring exception handling. Analyze claims for potential fraud by member or pharmacy. Research to define values for missing information not submitted with claim but required for processing. Utilize internal systems, resources and / or making out bound calls to pharmacies for missing information. Initiate correspondence to members, pharmacies or other internal departments for claim denials, missing information, or other claim issues. Navigate daily through multiple platforms to research and accurately finalize claim submissions. Adhere to strict HIPAA regulations especially when communicating to others outside of Express Scripts. Miscellaneous duties / projects as assigned.

The candidate must reside in one of the following counties in Illinois or Missouri :

• Illinois : Bond, Calhoun, Clinton, Jersey, Madison, Monroe, St. Clair.
• Missouri : Franklin, Jefferson, Lincoln, St. Charles, St. Louis County, St. Louis City, Warren

Key Qualifications :

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 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.