Med Claim Rev Specialist

Description:
THESE POSITIONS MAY BE LOCATED IN EITHER CHARLOTTE, NC OR CHATTANOOGA, TN.

Provides medical interpretation and decisions on identified health claims based on contractual benefits and medical circumstances and develops recommendations for resolution of questionable claims requiring further professional or committee review. Requires an RN with two or more years of healthcare experience..Provides medical interpretation and decisions on identified health claims based on contractual benefits and medical circumstances and develops recommendations for resolution of questionable claims requiring further professional or committee review. Requires an RN with two or more years of healthcare experience..

Qualifications:
RN with active nursing license.
3 years clinical experience required.
Minimum of 3 years experience in managed care.
One to two years Utilization Management experience, Case Management strongly preferred.
Strong written and oral communication skills.
Ability to effectively communicate with clinical and non-clinical personnel.
Knowledge of state and regulatory standards.
Managed Care, PPO, Indemnity Product knowledge.
Strong time management and organizational skills.
Ability to handle multiple duties with excellent prioritizing skills.
Strong analytical skills.
Proficient in the use of PC; strong keyboarding skills.
Requires minimal direction on highly complex/sensitive issues.

Salary/Benefits: Salary commensurate with experience
CIGNA offers a competitive compensation and comprehensive benefits package including health and wellness benefits, 401k plan, and work/life balance programs, as well as opportunities for career growth and development.

Job Location: Charlotte, NC

Job Number: 42923

Company URL: www.CIGNA.com