Remote Medical Claims Auditor – Cigna Healthcare

Cigna Healthcare is seeking a detail-oriented and analytical Remote Medical Claims Auditor to join our team. In this role, you will be responsible for reviewing and auditing medical claims to ensure accuracy, compliance, and adherence to Cigna’s policies and industry standards. As a Remote Medical Claims Auditor, you will play a critical role in identifying discrepancies, preventing fraud, and improving the overall quality of claims processing, all while working from the comfort of your home.

If you have a strong background in medical claims, auditing, and healthcare compliance, this is an excellent opportunity to leverage your skills in a remote role that offers both flexibility and impact.

Key Responsibilities:

• Claims Auditing & Review: Review and audit medical claims for accuracy, ensuring they comply with Cigna’s policies, industry regulations, and contractual agreements.
• Compliance & Accuracy: Ensure that claims adhere to regulatory requirements, including HIPAA, and that all necessary documentation is complete and accurate. Identify any inconsistencies or errors and take appropriate action.
• Identify Billing Issues: Detect and investigate billing discrepancies, overpayments, and underpayments, and provide recommendations for corrective actions.
• Data Analysis: Analyze medical claims data to identify trends, patterns, and potential fraud, waste, or abuse. Provide reports and insights to management to support process improvements.
• Collaboration: Work closely with claims processors, customer service teams, and healthcare providers to resolve audit findings and improve claims processing accuracy.
• Process Improvement: Suggest and implement process improvements to enhance efficiency and accuracy in claims auditing and processing.
• Documentation & Reporting: Maintain accurate records of audit findings, issues, and resolutions. Prepare reports to communicate audit results and trends to management and stakeholders.
• Training & Education: Educate internal teams on audit findings and help improve understanding of policies and procedures related to medical claims auditing.

Required Qualifications:

• High school diploma or equivalent; Associate’s degree in healthcare administration, business, or a related field preferred.
• 3+ years of experience in medical claims auditing, medical coding, or a similar role within the healthcare or insurance industry.
• Strong understanding of medical billing, coding (ICD-10, CPT, HCPCS), and healthcare reimbursement processes.
• In-depth knowledge of healthcare compliance regulations, including HIPAA, CMS guidelines, and payer requirements.
• Experience with claims management systems and tools used for auditing, processing, and reviewing medical claims.
• Strong analytical skills and attention to detail, with the ability to identify errors and discrepancies in complex claims data.
• Excellent communication skills, both written and verbal, to interact with team members and healthcare providers.
• Ability to work independently, manage multiple priorities, and meet deadlines in a remote environment.

Preferred Qualifications:

• Certification in Medical Coding (CPC, CCS, or similar) or Medical Auditing (CPMA) is a plus.
• Experience with claims auditing in a managed care or health insurance environment.
• Knowledge of fraud detection techniques and claims review for potential fraud, waste, and abuse.
• Familiarity with claims auditing software and data analytics tools.

Why Cigna?

• Work from Home Flexibility: Enjoy the convenience and flexibility of a remote position while making a meaningful contribution to the healthcare claims process.
• Career Growth: Cigna offers opportunities for career development, including training programs, certifications, and advancement within the company.
• Comprehensive Benefits: Cigna provides a competitive benefits package that includes healthcare, dental, vision, wellness programs, retirement plans, and more.
• Inclusive Culture: Cigna values diversity and strives to foster an inclusive work environment where employees are supported and encouraged to succeed.

How to Apply: If you are a medical claims expert with an eye for detail and a passion for ensuring accuracy and compliance, apply now to join Cigna as a Remote Medical Claims Auditor!