Remote Cigna Claims Representative Jobs in Raleigh, NC

Under close supervision, handles liability and property claims within designated authority. Resolves coverage and/or liability issues in accordance with applicable state insurance laws, regulations, and procedures.

• There are three positions available. Selected candidates will report to Breanna Neill, Kristin Sanders or Robert Tetterton.
• Work location: This is a remote, work-from-home position. Candidates located within proximity to ERIE's Raleigh Branch Office are preferred.
• Schedule: The primary schedule is 8:00 a.m. - 4:30 p.m., Monday through Friday, Eastern Time. Rotating weekday evening and Saturday shifts are required based on business and service-level needs. Schedule is subject to change based on business needs.
• Licensing: The selected candidate must obtain all required state licensing within 45 days of employment.
• Remote work requirements: Employees working remotely must have access to internet service with minimum speeds of 50 Mbps download and 10 Mbps upload. 

• Investigates and adjudicates claims within designated authority, ensuring compliance with appropriate statutory laws. Verifies coverage, establishes and maintains reserves, secures recorded statements, drafts and processes correspondence, reports and records. Obtains additional information as required to determine liability.  Documents claim files and facilitates processing of claims in collaboration with other departments. Assigns outside experts when necessary to assist in investigation and in support of potential recovery.
• Establishes contact with all parties involved in the claim in accordance with ERIEAAAs expectations.
• Evaluates and negotiates claims, recognizes subrogation opportunities, and initiates action. Sets up and/or issues payment using ERIEAAAs approved payment methods for settlement; or declines payment within designated authority.
• Responds to inquiries from Policyholders, Agents, insurance carriers, claimants, assigned experts and others.
• Learns and maintains knowledge of liability laws for each state. Learns and maintains knowledge of motor vehicle codes. 
• Learns and maintains knowledge of no fault/medical management/FPB laws for each state, including recognition of bodily injury claims.
• With supervisor guidance, responds to intercompany arbitration applications. Files contentions and supporting documents on behalf of the insured/driver.
• Conducts research, attends industry-related training programs and other training sessions to stay current on policy changes, interpretation, or new legislation.
• Provides support for property claims during periods of heavy volume.

The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.
Regular and predictable attendance is an essential job function. For certain positions at ERIE, including leadership roles, regular and predictable onsite presence may also be an essential job function based on business and operational needs.
This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become clear.

Minimum Educational and Experience Requirements 

• High school diploma or GED and two years of related claims handling or customer service experience, or equivalent educational experience required.  
• Bachelor's or Associate's degree preferred.

Designations and/or Licenses 

• Successful completion of Introduction to Insurance (INTRO) and Introduction to Claims (AIC 30) preferred.
• Obtain appropriate licenses as required by state within 45 days of employment in the role for external applicants and 90 days of employment in the role for internal applicants.