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

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Demonstrates expertise in managing appeals processes, including reviewing claims, assessing compliance with Standard Operating Procedures, and effectively communicating decisions. Proficient in utilizing multiple systems to drive process improvements and ensure timely resolutions.

Highest-signal resume keywords

Appeals ManagementProclaim/Facets SystemsProcess ImprovementVerbal and Written CommunicationAttention to Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewStandard Operating ProceduresRegulatory ComplianceData AnalysisDocumentation Preparation

Soft Skills

OrganizationTime ManagementAdaptabilityMultitaskingProblem Solving

Tools & Technologies

IComplyBenefit AccessOneViewIView

Certifications & Qualifications

High School Diploma or Equivalent

Industry Keywords

HealthCareAppeals ProcessFederal RegulationsState Regulations

About the role

Key responsibilities & impact

Review incoming Appeals from Customers, Clients and HealthCare Professionals
Research item being appealed against Standard Operating Claim Payment Procedures and/or State and Federal Regulations in IComply, and Benefit Access
Determine if the claim issue in question was paid correctly or needs an adjustment
Adjust overturned appeals or appropriately route the appeal for adjustment
Manage personal inventory and aging by use of daily reports provided
Prepare and route appeals requiring clinical review to the Clinical Appeals Team
Create and issue documentation explaining appeal decision

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
Internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload for employees working at home
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances

Benefits

Comp & perks

Remote work arrangement
Cable broadband or fiber optic internet requirement for work-from-home employees