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
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
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.