Cigna Group Claims Analyst in Pittsburgh, Pennsylvania

It's fun to work in a company where people truly BELIEVE in what they are doing!

We're committed to bringing passion and customer focus to the business.

Help our customers maintain their health, well being and sense of security by providing swift, accurate evaluation of the various accident products. Accident Specialists partner with medical, legal and other expert resources to research, evaluate and process new and existing accidental death and dismemberment, special accident, business travel accident, accidental permanent and total disability claims, accidental short term disability and medical claims to determine the company’s financial liability with assistance from Technical Specialists and Team Leader as necessary.

  • Demonstrates strong analytical and negotiation skills to solve complex claim and customer issues

  • Demonstrates ability to understand, interpret and effectively communicate contractual language

  • Works with business partners to ensure successful implementation of new accounts as well as changes on additional lines of business with existing accounts

  • Accountable for own decisions and honors both internal and external commitments

  • Accepts challenges and demonstrates accountability for own developmental opportunities

  • Evaluates eligibility, benefit amounts and appropriate beneficiary status based on contract policies

  • Interprets and evaluates accident policy, police, autopsy, toxicology, and forensic investigative reports and foreign documents as well as medical records and reports

  • Reviews and interprets claim documents against the applicable contract provisions including exclusions, limitations, material misrepresentations and fraud

  • Effectively interacts with medical and legal staff to determine accurate claim decisions within the confines of the policy and prevailing jurisdictional opinions

  • Provides policyholders and beneficiaries or claimants with clear and understandable explanations to inquiries regarding claim issues

  • Provides exceptional performance according to published quality and compliance standards including Performance Guarantees

  • Ensures business objectives are achieved in a highly compliant and ethical manner consistent with governing laws and regulations including, but not limited to, Sarbanes-Oxley and SAS 70 Controls

  • Works closely with Technical Specialist and Team Leader to ensure appropriate claim actions and expert partnering

  • Demonstrates excellent knowledge of Cigna Group Operations and Corporate Compliance, Policies and Procedures and best practices and continues to keep current with updates and changes to those requirements.

  • Stays abreast of ongoing trainings associated with role and business unit objectives

  • Demonstrates solid planning and organizational skills with the ability to address short and long term goals while prioritizing and addressing ongoing issues

  • Supports customer centricity by proactively identifying customer needs and creating innovative solutions to meet customer challenges. Looks for new ways to accomplish objectives and takes extra steps to deliver customer service that meets and exceeds expectations.

  • Ensures a consistent high performance work culture exists

Responsibilities:

Preferred Qualifications :

  • BA/BS degree or equivalent work experience

  • Master Degree in Forensic Science highly desired

  • Demonstrated ability to problem solve, utilize analysis, experience and judgment to make accurate decisions

  • Clear and concise and timely professional communications using all mediums

  • Experience in delivering exceptional customer service

  • Strong drive for results

  • Team oriented focus with ability to perform at the highest level

  • Ability to prioritize critical objectives focusing on high impact components

  • Maintains professionalism and flexibility despite conflicting demands

  • Executes decisiveness even when dealing with ambiguity

  • Ability to learn process and product information and adapt quickly and effectively

  • Strong analytical skills and ability to comprehend and clarify complex concepts

  • Excellent interpersonal, organizational, negotiation, conflict resolution and presentation skills

  • Integrity, objectivity and personal accountability

  • Proficient in Microsoft Office

Preferred


Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.

.

If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

We’re a global health service company dedicated to helping people improve their health, well-being and sense of security. We offer an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products that serve over 95 million customers around the world. When you work with us, you’ll enjoy a different kind of career - you’ll make a difference, learn a ton, and change the way people think about health insurance. To see our culture in action, search #TeamCigna on Twitter or Instagram.