Group Claims Representative

  • Location

    Plano, United States

  • Sector:

    Other Area(s)

  • Job type:


  • Contact:

    Leric Arcigal

  • Job ref:


  • Published:

    about 1 year ago

  • Expiry date:


  • Please do not submit any candidates previously rejected on Req #9415631 or Req #9566141*

Helps our customers maintain their health, well-being, and sense of security by managing an assigned caseload of disability claims under guidance. Evaluates customer eligibility based on contractual, state, and federal guidelines; communicates decisions in writing, calculates, and issues benefit payments. Follows-up on and reviews Social Security decisions and other income benefits. Helps customers through difficult times by following-up on their medical progression and discussing return to work options. Partners with medical, vocational, and other expert resources to develop a plan to address disability obstacles between the customer, attending physician, and client to facilitate a successful return to work on a full-time or modified-duty basis.

Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information Pays all covered claims accurately and timely Executes on all customer performance guarantees Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner Ability to handle potentially high levels of call volume from customers and clients Exhibits claim management performance according to quality and compliance standards Manages both new claims and open claims equally and maintains decision times Adheres to standard timeframes for processing mail, tasks and outliers Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.) Demonstrates focus on team and office goals by developing an understanding of relationships with our business partners and positively interacting with business partners as needed Understands Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices Stays abreast of ongoing trainings associated with role and business unit objectives