Appeals Processing Senior Representative at Cigna in Bloomfield, Connecticut

Job Description:

The Clinical Appeals Senior Associate (CASA) collects non-clinical data utilizing pre-formatted templates and transfers this information to the clinical professional staff; screens information from targeted claims related to clinical and mental health services, clinical/mental health denial/appeal letters and their respective submitted records for denied clinical/mental health services for the pre-formatted transactional template. The CASA performs other assignments that do not require evaluation or interpretation of clinical information; consults with Utilization Review Nurses, Licensed Clinical Managers and Clinical Quality Program Support personnel; determines required expert resources at each juncture and solicits input appropriately. Licensed Health Professionals (clinical staff) are available to the non-clinical staff while they are performing their duties via face-to-face availability, telephonic or electronic connectivity. Proactively communicates with claimants, employers, providers and the original case manager, if applicable, to resolve investigation issues and communicate decisions/rationale for denial or approval as directed by clinical personnel, if applicable. Conducts OP post-service administrative claims or appeals coverage determinations (such as bundling reviews) for which they are empowered outside of Cigna's clinical UM program requirements. Applies all benefit plan limitations/exclusions and applicable federal and state regulatory requirements to each case review, including PPACA. Also conducts Adult Dependent Handicapped administrative eligibility reviews based on National policies and job aids. Keeps all HIPAA regulatory requirements.

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 19 - 29 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 .

About Cigna

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?

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

Cigna 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.