The Cigna Group
Healthcare
MedicalClaimsReviewSeniorAnalyst
“Medical Claims Review Senior Analyst at The Cigna Group. Skills: Claims review, Medical policies, Coding and billing. Evaluate medical information against criteria. Determine necessity for procedure”
Industry & Context.
Problem solving
What They're Looking For.
Must Have
MBBS, Maintain active Medical license, 3+ years clinical experience, MS Office Suite experience
Nice to Have
Utilization Review experience, Claim Review experience, Health insurance experience, Knowledge of Health Care Reimbursement
What You'll Do.
Evaluate medical information against criteria
Determine necessity for procedure
Refer to Medical Director
Evaluate itemized bills against policies
Adhere to quality assurance standards
Facilitate understanding of products
Handle escalated claims
Secure supervisory assistance
Advise supervisory staff of concerns
Interact with Health Care Professionals
Participate on special projects
Perform random reviews
Perform focused reviews
Analyze clinical information
Perform claim reviews
Focus on coding errors
Focus on billing errors
Identify cases for fraud
Identify cases for abuse
Refer cases for fraud
Refer cases for abuse
Refer questionable billing practices
Handle multiple products
Handle multiple benefit plans
How You'll Work.
Team & Collaboration
Matrix partners
Communication Scope
Effective communication; Courtesy; Professionalism
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