We provide extensive medical & well-being benefits, including coverage for dental check-ups, gym memberships, pre & post natal treatments, etc.

Comprehensive Medical & Well-being Coverage

Achieve a better work-life balance with our hybrid work model, allowing you to work from home on designated days.

Hybrid Work Environment

Benefit from our comprehensive insurance package which includes five different types of coverage to meet your varied needs.

Diverse Insurance Options

Gain international experience and collaborate with a diverse, multinational team, enhancing your global perspective and professional growth.

 Global Exposure

We prioritize your health and well-being by offering fresh fruits daily in the office.

Wellness Initiatives

Receive a generous travel allowance to support your commuting needs, ensuring a smooth and stress-free journey to work.

 Travelling Allowance

Cigna International Health Services Sdn Bhd

&nbsp;We’re dedicated to improving the health and vitality of those we serve. Through our divisions, Cigna Healthcare and Evernorth Health Services, we work to enhance the lives of our clients, customers, and patients. 
Together with our colleagues around the world and our 190+ million customer relationships, we drive growth and improve lives. 
Here, we believe relationships matter and we build ours on respect, empathy, and trust.&nbsp;

Life at The Cigna Group

<h2>Our Mission</h2>
To improve the health and vitality of those we serve.
<h2>Our Vision</h2>
A better future built on the vitality of every individual and every community.

Cigna Mission and Vision

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
<ul>
<li>Processes claims from members and providers.</li>
<li>Assists queries from providers and payers via phone calls or e-mails.</li>
<li>Maintains files for authorizations and other reports.</li>
<li>Assesses and processes claims in line with the policy coverage and medical necessity.</li>
<li>Be fully versed with medical insurance policies for various groups / beneficiaries.</li>
<li>May assist in training colleagues and asked to share knowledge.</li>
<li>Accurately assesses eligibility within the policy boundaries.</li>
<li>Monitors and maintains the claims processing as per the defined terms and policy of the organization.</li>
<li>Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis.</li>
<li>Monitors the qualitative and quantitative measures for claims &amp; pre-approvals.</li>
<li>Ensures compliance to any changes in terms of system parameters or process.</li>
<li>Maintains quality as per framework for accuracy.</li>
<li>Maintains productivity and responsiveness to the work allocated.</li>
<li>Collaborate with other stakeholders / teams to resolve queries including complex queries.</li>
<li>Actively support all team members to enable operational goals to be achieved.</li>
<li>Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).</li>
<li>Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality.</li>
<li>Accurate data input to the system applications.</li>
<li>Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods.</li>
<li>Following up own workload (volume and timing): keeping an eye on chronology and processing time of the work volume and taking suitable actions.</li>
<li>Participate efficiently in processing the flow of claims: inform the supervisor about claims lacking clarity and about possible ways of optimizing the processes.</li>
<li>A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactions are important motivators.</li>
<li>Monitor and highlight high-cost claims and ensure relevant parties are aware.</li>
<li>Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and TAT target on claims adjudication.</li>
<li>Adjust error claims according to actual situation.</li>
<li>Well handle recoupment and reconciliation work, communicate with providers and members via call and email for collection and explanation.</li>
<li>Work with cross function teams, such as Finance, CSR, Eligibility, Network, Client Management, etc. Ensure recoupment work go smoothly.</li>
<li>Actively support Team Leader and work with claim colleagues to enable all operational goals to be achieved</li>
</ul>

This job is a Claims Representative. You might like this job because you&#x27;ll process claims, assist with inquiries, maintain files, and ensure accurate medical coverage details, all while meeting processing targets and ensuring compliance with policies.

Medical Insurance Claims

Claims Processing

Biomedical Sciences

Medical Terminology

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



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