Claims Examiner - Refund Specialist - Evicore - Remote at Cigna in Bloomfield, Connecticut

Job Description:

Do you want to improve the health and vitality of those we serve? EviCore a division of The Cigna Group is hiring a Claims Examiner - Refund Specialist. You'll be responsible for resolving open credit balances and processing refunds to health plans and/or providers . The role will consist of analyzing correspondences such as EOBs/ERAs and refund requests to address potential overpayments and reconcile accounts with open credit balances. The candidate will work closely with the finance team, claims team, and accounts receivable team. Other duties include:

How you will make a difference:

• Process refunds in a timely manner based on contractual language


• Navigate through various systems to ensure accurate and timely resolution of claims with credit balances or overpayments


• Process insurance reimbursement requests


• Report and track trends and issues


• Applying coinsurance and coordination of benefits to claims


• Handle return checks from health plans


• Review and respond to insurance refund requests


• Comply with state/federal regulations and adhere to HIPAA and PHI guidelines


• Assist with additional payment-related functions as necessary

What you will need to succeed:

• High school graduate or GED required


• 1+ years of medical refund processing/insurance collection experience strongly preferred


• Proficiency with navigating MCRS and PMC platforms required


• 1+ years of claims experience required


• 1 + years of in-depth knowledge of medical terminology, claims processing, and revenue cycle related functions, required


• Understanding of refund and credit guidelines, strongly preferred


• Understanding of Explanations of Benefits (EOBs) and Electronic Response Admittances (ERA) strongly preferred


• Exhibit excellent written and oral communication skills


• Proficient in Microsoft Office Products (Word, Outlook, Excel)


• Can work both independently and collaboratively with a team


• A high level of accuracy, attention to detail, planning, organizational skills and have a dedicated approach to work

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 - 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 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: 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.

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.