Claims representative - Cigna Healthcare

Overview

Claims representative role handling international insurance claims processing for member claims, delivering basic technical, administrative and operative claims tasks under direct instruction and close supervision.

What you'll do

• Examine and process paper claims and/or electronic claims.
• Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• Complete data entry, maintain files, and provide support.
• Monitor and highlight high-cost claims and ensure relevant parties are aware.
• Monitor turnaround times to ensure claims are settled within required time scales, highlighting to your Supervisor when this is not achievable.
• Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible.
• Interface effectively with internal and external customers to resolve customer issues.
• Identify potential process improvements and make recommendations to team senior.
• Actively support other team members and provide resource to enable all team goals to be achieved.
• Work across International business in line with service needs.
• Carry out other ad hoc tasks as required in meeting business needs.
• Work cohesively in a team environment.
• Adhere to policies and practices, training, and certification requirements.

What you'll need

• Graduate (any field).
• Minimum 1 year of experience in healthcare services or processing of healthcare insurance claims.
• Expertise in international insurance claims processing.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Good English language communication skills, both verbal and written.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Ability to meet/exceed targets and manage multiple priorities.
• Excellent attention to detail, with a high level of accuracy.
• Strong interpersonal skills.
• Strong customer focus with ability to identify and solve problems.
• Ability to work under own initiative and proactive in recommending and implementing process improvements.
• Ability to organise, prioritise and manage workflow to meet individual and team requirements.

Nice to have

• Experience in medical administration, claims environment or Contact Centre environment.
• Degree preferably in medical, paramedical, pharmacy or nursing.

Details

• Location: Bengaluru (Bangalore), India.
• Work timings: 7:30 am to 4:30 pm IST.