Senior Appeals Processing Representative

The Cigna Group

. Review incoming appeals from customers, clients and healthcare professionals .

Posted 10/28/2026full-timeRemote • New Hampshire • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing appeals processes, including reviewing claims, adjusting overturned appeals, and preparing documentation. Proficient in utilizing multiple systems to ensure compliance with Standard Operating Claim Payment Procedures and relevant regulations.

Highest-signal resume keywords

Claims ReviewProclaim/Facets SystemsProcess ImprovementExcellent Communication SkillsAttention To Detail

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AdjustmentAppeals ManagementRegulatory ResearchDocumentation PreparationTrend Assessment

Soft Skills

OrganizationTime ManagementAdaptabilityMultitaskingWorking Under Pressure

Tools & Technologies

IComplyBenefit AccessOneViewIView

Certifications & Qualifications

High School Diploma

Industry Keywords

Standard Operating ProceduresHealthcare AppealsFederal RegulationsState Regulations

About the role

Key responsibilities & impact

Review incoming appeals from customers, clients and healthcare professionals
Research appealed items against Standard Operating Claim Payment Procedures and/or state and federal regulations in IComply and Benefit Access
Determine whether claims were paid correctly or require adjustment
Adjust overturned appeals or route appeals for adjustment
Manage personal inventory and aging using daily reports
Prepare and route appeals requiring clinical review to the Clinical Appeals Team
Create and issue documentation explaining appeal decisions

Requirements

What you’ll need

High School Diploma or equivalent required
Proclaim/Facets systems, OneView and iView knowledge is preferred
Able to manage multiple tasks and work under pressure in a fast paced environment
Excellent verbal and written communication skills
Strong attention to detail and the ability to work in multiple systems concurrently
Strong organization and time management skills; effectively adapts to multiple and/or competing priorities
Process improvement skills; ability to assess trends, processes and barriers to drive positive outcomes for resolutions
If working from home, internet connection through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload

Benefits

Comp & perks

Remote work option (occasionally or permanently)
Internet service requirement for home working: cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload
Equal employment opportunity consideration
Reasonable accommodation support for the online application process
Tobacco-free policy and smoking cessation program eligibility where applicable