Claims Representative - Remote

Entry-Level Dental Claims Representative – Job Description SUMMARY The Dental Claims Representative is responsible for reviewing and processing dental claims in accordance with plan benefits, eligibility, and internal policies. This entry-level role is ideal for individuals beginning their career in healthcare operations, offering hands-on experience in dental claims processing and exposure to industry-standard tools and practices. Representatives will be trained to accurately adjudicate claims, identify discrepancies, and ensure timely resolution. Success in this role is measured by accuracy, productivity, and a commitment to learning and development. RESPONSIBILITIES Review and process dental claims using established procedures and guidelines. Verify member eligibility and plan benefits to determine appropriate claim outcomes. Accurately enter and update claim information in the system. Identify and flag claims requiring additional documentation or review. Collaborate with team members and supervisors to resolve claim issues. Participate in training sessions and team meetings to build knowledge and skills. Utilize virtual tools such as Outlook, Webex, and internal platforms to communicate and stay connected with team members and leadership. Maintain confidentiality and adhere to HIPAA and other regulatory requirements. QUALIFICATIONS High school diploma or equivalent required; associate’s or bachelor’s degree preferred. Strong attention to detail and a willingness to learn. Basic understanding of dental terminology and/or RDA/RDH is a plus, but not required. Proficient in Microsoft Office applications, especially Outlook and Excel. Strong written and verbal communication skills. Ability to work in a fast-paced, deadline-driven environment. Excellent organizational and time management skills. Customer service or administrative experience in a healthcare or dental setting is a plus. GROWTH OPPORTUNITIES This role offers a clear path for advancement into more specialized or senior claims roles, including opportunities to: Support cross-functional projects. Train as a subject matter expert (SME). Participate in quality improvement initiatives. Gain exposure to multiple claims platforms and processes. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.