The Cigna Group
ClaimsRepresentative(GEHAPAC)
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Claims Representative (GEH APAC) at The Cigna Group. Skills: Claims processing, Policy assessment, Data input. Serve providers and insurance companies. Determine requirements”
What You'll Achieve.
Achieve processing targets; Meet Service Level Agreement requirements; Meet team KPI(s); Meet monthly quality audit scores; Meet NPS; Maintain quality; Maintain productivity; Maintain responsiveness; Enable operational goals achievement
Industry & Context.
Resolve problems; Resolve queries; Problem identification
Work in shifts, Work on staggered weekends
What They're Looking For.
Must Have
1-2 years similar role experience, Administration awareness and experience, Microsoft Office applications skills, First class written communication, First class verbal communication, Ability to communicate across diverse population, Capable of working independently, Capable of working as part of a team, Good time management, Ability to work to tight deadlines, Flexible and adaptable approach, Confident in calling out issues, Flexible to work in shifts, Flexible to work on staggered weekends
Nice to Have
Experience working for international company, Claims processing experience, Insurance experience, Broad awareness of medical terminology
What You'll Do.
Serve providers and insurance companies
Determine requirements
Process claims per benefit terms
Provide medical coverage details
Maintain pre-approvals
Process claims per defined terms
Process claims per policy
Assist queries via phone
Assist queries via e-mail
Maintain files for authorizations
Maintain other reports
Assess claims per policy coverage
Assess claims per medical necessity
Be versed with medical insurance policies
Assist in training colleagues
Assess eligibility within policy boundaries
Monitor claims processing per defined terms
Monitor claims processing per policy
Achieve required processing targets
Monitor qualitative measures
Monitor quantitative measures
Ensure compliance to system changes
Ensure compliance to process changes
Maintain quality for accuracy
Maintain productivity
Maintain responsiveness
Collaborate with stakeholders to resolve queries
Collaborate with teams to resolve queries
Enable operational goals achievement
Meet Service Level Agreement requirements
Meet monthly quality audit scores
Assess claims for medical expenses
Maintain medical confidentiality
Perform accurate data input
Position self analytically
Position self critically
Follow own workload chronology
Follow own workload timing
Take suitable actions on workload
Participate in claims flow processing
Inform supervisor about claims lacking clarity
Inform supervisor about process optimization ways
Sustain effort towards high-quality claims handling
Sustain effort towards accurate reimbursements
Sustain effort towards fast transactions
Monitor high-cost claims
Ensure relevant parties are aware of high-cost claims
Follow Claim Manual strictly
Adjudicate claims according to benefit policies
Meet financial accuracy target
Meet procedure accuracy target
Meet TAT target on claims adjudication
Handle recoupment work
Handle reconciliation work
Communicate with providers for collection
Communicate with providers for explanation
Communicate with members for collection
Communicate with members for explanation
Work with cross function teams
Ensure recoupment work goes smoothly
Work with claim colleagues
Enable all operational goals achievement
How You'll Work.
Team & Collaboration
Collaborate with stakeholders; Collaborate with teams; Support team members; Work with cross function teams; Work with claim colleagues
Communication Scope
Written communication; Verbal communication; Communication across diverse population
Full Job Description
**JOB PURPOSE** ### The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per 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 DUTIES** * Processes 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 asked to share knowledge. * Accurately assesses eligibility within the policy boundaries. * Monitors and maintains the 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 the qualitative and quantitative measures for claims & pre-approvals. * Ensures compliance to any changes in terms of system parameters or process. * Maintains quality as per framework for accuracy. * Maintains productivity and responsiveness to the work allocated. * Collaborate with other stakeholders / teams to resolve queries including complex queries. * Actively support all team members to enable operational goals to be achieved. * Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score). * Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. * Accurate data input to the system applications. * Positioning him/herself analytically and critically in the context of cost m
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