Claims representative

Job Description*

• Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles.

 

Responsibilities: -

• Adjudicate international medical/dental and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• Monitor and highlight high-cost claims and ensure relevant parties are aware.
• Monitor turnaround times to ensure your 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 European 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.

Requirements*:

• 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.
• Must possess 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.
• Experience in medical administration, claims environment or Contact Centre environment is advantageous but not essential.

 

Education*: Graduate (Any) - medical, Paramedical, Commerce, Statistics, Mathematics, Economics or Science.

Experience Range*: Minimum 2 years and up to 4 years of experience in processing of healthcare insurance claims.

Foundational Skills* - Expertise in EU insurance claims processing

Work Timings*: 1:00-10:00 PM IST

Job Location*: Bengaluru (Bangalore)

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.