Claims Processor

4 weeks ago


Toronto, Ontario, Canada The Cigna Group Full time

The Cigna Group is seeking a highly skilled Claims Processor to join our team in the administration of Health Canada Dental Claim Adjudication. This role entails adjudicating Non-Insured Health Benefit Dental Claims for indigenous people in Canada.

The successful candidate will be responsible for registering, reviewing, validating, and adjudicating claims on a daily basis. They will also be responsible for monitoring and handling pended claims to ensure they are settled according to the Service Level Standards.

This role contributes to The Cigna Group by meeting our Claims Processing Service Levels which contributes to customer satisfaction and minimizes risk of financial penalties.

Key Responsibilities:

  • Registers, reviews, validates, and adjudicates claims on a daily basis as per processes to meet minimum accuracy Service Level Standards.
  • Monitors and handles pended claims to ensure they are settled according to the Service Level Standards.
  • Return Claims that are missing mandatory client/benefit information as per using either claim entry or the doc reg screen and entering reason for the return. Address envelopes and attach provider return letter to claim and have clerical department send out all returns same day.
  • Claim Adjustments that are given to processors by call centre/Supervisor/Senior Processors/QA Analyst due to errors are scanned and reviewed to ensure an error has been made, once a claim is adjusted, the information is fed back to call centre to be logged as complete.

Requirements:

  • Experience with data entry, excellent accuracy
  • Experience working in an operational setting an asset
  • Experience in the group health insurance industry an asset Strong focus on customer service is required
  • Ability to work effectively in a fast paced, rapidly changing environment
  • Excellent organizational and interpersonal skills
  • Ability to work within a team
  • Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook)
  • Ability to work or interpret data independently

About The Cigna Group:

The Cigna Group is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.

We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.


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