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Claims Adjudication Specialist
2 months ago
Position Overview:
The Cigna Group is dedicated to providing exceptional health services and is currently seeking a Claims Adjudication Specialist. This role focuses on the evaluation and processing of Non-Insured Health Benefit Dental Claims for Indigenous communities across Canada.
The Claims Adjudication Specialist is responsible for the registration, examination, validation, and adjudication of claims on a daily basis, ensuring the integrity of data within our systems. This position involves processing claims for Pay Providers, Pay Clients, and Client Reimbursements across various regions, with a commitment to resolving all pending claims within established turnaround times.
This role plays a critical part in achieving our Claims Processing Service Levels, which enhances customer satisfaction and mitigates the risk of financial penalties.
Key Responsibilities:
- Register, review, validate, and adjudicate claims daily in accordance with documented processes.
- Monitor and manage pending claims to ensure timely resolution in line with Service Level Standards.
- Maintain a minimum accuracy standard of 98% consistently.
- Meet productivity targets for assigned quotas within established Service Delivery Standards.
- Engage in regular quality and productivity assessments.
- Participate in bi-weekly departmental meetings and monthly benefit process discussions.
- Process claim adjustments as directed by various departments.
- Complete annual Privacy and Compliance Training.
Qualifications:
- Minimum of 1 year of data entry experience with a proven track record of accuracy.
- Experience in an operational environment is advantageous.
- Familiarity with the group insurance sector is a plus.
- Proficient in verbal and written communication in English.
- Strong customer service orientation is essential.
- Ability to learn quickly and make informed decisions with minimal oversight.
- Excellent analytical skills and capability to interpret data independently.
- Self-motivated with the ability to thrive in a fast-paced, dynamic environment.
- Exceptional time management, organizational, and interpersonal skills.
- Proficient in Microsoft Office Suite (Word, Excel, Outlook).
Note: Successful candidates will be required to obtain an Enhanced Reliability Clearance from the Federal Government, providing necessary documentation as needed.
About The Cigna Group:
The Cigna Group is a leading health service organization committed to enhancing the health and well-being of those we serve. We offer a comprehensive suite of health services, including medical, dental, behavioral health, pharmacy, and vision care, ensuring our clients receive superior healthcare solutions in a cost-effective manner.
We pride ourselves on fostering a diverse, inclusive, and accessible workplace, empowering our employees to reach their full potential. We are committed to creating a barrier-free working environment and are prepared to provide accommodations for individuals with disabilities.
