CIGNA Worldwide General Insurance Company Limited View all jobsThe job holder is responsible for serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining the database.
He/She is responsible for processing as per the terms of benefits.
He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.RESPONSIBILITIES AND DUTIESProcesses claims from members and providers.Assists queries from providers and payers via phone calls or e-mails.Maintains files for authorizations and other reports.Assesses and processes claims in line with the policy coverage and medical necessity.Be fully versed with medical insurance policies for various groups/beneficiaries.May assist in training colleagues and share knowledge.Accurately assesses eligibility within the policy boundaries and monitors claims processing as per the defined terms and policy of the organization.Achieves required processing targets assigned by the team leader on daily, weekly, and monthly basis.Monitors qualitative and quantitative measures for claims & pre-approvals.Ensures compliance with any changes in terms of system parameters or process.Maintains quality as per framework for accuracy.Maintains productivity and responsiveness to the work allocated.Collaborates with other stakeholders/teams to resolve queries including complex queries.Actively supports all team members to enable operational goals to be achieved.Meets or exceeds Service Level Agreement requirements, team KPI(s), monthly quality audit scores, and NPS (Net Promoter Score).Assesses and processes claims for medical expenses while maintaining medical confidentiality.Accurate data input to the system applications.Follows up on own workload (volume and timing) and takes suitable actions.Participates efficiently in processing the flow of claims, informing the supervisor about claims lacking clarity.Monitors high-cost claims and ensures relevant parties are aware.Follows Claim Manual and SOP strictly, adjudicates claims according to benefit policies, and meets both financial/procedure accuracy and TAT targets on claims adjudication.Handles recoupment and reconciliation work, communicates with providers and members for collection and explanation.Works with cross-functional teams to ensure recoupment work goes smoothly.Actively supports Team Leader and collaborates with claim colleagues to achieve operational goals.KNOWLEDGE, SKILLS AND EXPERIENCEAt least 1-2 years of experience performing a similar role.Fluent in English; experience working for an international company preferred but not essential.Claims processing or insurance experience preferred but not essential.Broad awareness of medical terminology advantageous.Excellent organizational skills, capable of following and contributing to agreed procedures.Strong administration awareness and experience essential.Strong skills in Microsoft Office applications essential.First-class written and verbal communication skills essential.Ability to communicate across a diverse population essential.Capable of working independently or as part of a team; good time management skills and ability to work to tight deadlines.Flexible and adaptable approach, sometimes working in a fast-paced environment.Passion for achieving agreed objectives.Confident in addressing issues as they arise.Should be flexible to work in shifts and on staggered weekends.COMMUNICATIONS AND WORKING RELATIONSHIPS
The job holder must ensure building strong effective relationships with all matrix partners and demonstrate approachability and openness.
He/She must foster strong internal and external communication standards.About The Cigna Group
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life.
We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality.
Join us in driving growth and improving lives.#J-18808-Ljbffr