Job Description Updates appeals tracking system, consults with Appeals Analyst Specialist regarding technical claims issues; determines required expert resources at each juncture and solicits input. Based on appeal investigation, determines whether claim is reopened or original denial was appropriate. Proactively communicated with claimants, employers, providers and the original case manager to resolve investigation issues and communicate decisions/rationale for denial/approval. Requires more than 2 years experience in billing, claims, customer service or health insurance; familiarity with state and federal regulations, medical terminology, CPT-4 and ICD-9 codes..
-Analyze claims and related material including history to determine correct codes and coverage were applied.
-Research problems and provide educational instructions to providers and members.
-Key claim adjustments and resolve on line payments.
-Compose formal letters of review determinations and other issues.
-Manage assigned workload to completing within timeliness metrics
Must have experience at the Proclaim Skills 2 level and processing hospital claims.
This role requires more than 2 years experience in claims/proficiency with Proclaim (Cigna Specific Claims Payment Platform), familiarity with state and federal regulations, medical terminology, CPT-4 and ICD-9 codes.
CIGNA - 22 months ago
With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...