The Cigna Group offers a reasonable amount of paid time off and many other benefit programs that allow you to take time away.

Rewards & time away

We offer five core medical plan options that cover in-network preventive care, which includes well child visits, physicals, and more!

Medical benefit

We offer dental and vision plan options for employees to choose from. Both options cover preventive care at no cost.

Dental & vision

We have an Educational Development Program that supports employees in their professional development and growth.

Financial support

The Cigna Group

The Cigna Group℠ is a global health company committed to improving health and vitality. We relentlessly challenge ourselves to partner and innovate solutions for better health. Our global workforce of more than 70,000 colleagues work through Cigna Healthcare℠ and Evernorth Health Services® to fulfill our mission to improve the health and vitality of the more than 178 million customer relationships we serve in more than 30 countries and jurisdictions.
We are guided by our mission–to improve the health and vitality of those we serve. To deliver on this, we know we must continually strengthen and evolve our capabilities and it’s why we put innovation at the heart of everything we do at The Cigna Group. Across Evernorth Health Services and Cigna Healthcare, we are driving new solutions, improving patient outcomes, and delivering for those we serve.
Source: <a href="https://www.thecignagroup.com/about-us/" target="_self">thecignagroup.com</a>

Who We Are

Our values guide how we work together; serve our customers, patients, clients, and communities; and deliver on our mission.
<ul>
<li>We care deeply about our customers, patients, and coworkers.&nbsp;</li>
<li>We partner, collaborate, and keep our promises.</li>
<li>We create a better future together.</li>
<li>We act with speed and purpose.</li>
<li>We innovate and adapt.</li>
</ul>
Source: <a href="https://www.thecignagroup.com/about-us/" target="_self">thecignagroup.com</a>

Our Values

JOB PURPOSE<h3> 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.</h3>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&nbsp;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>KNOWLEDGE, SKILLS AND EXPERIENCE<ul><li>At least 1-2 years of experience performing a similar role.</li><li>Experience of working for an international company, preferred but not essential.</li><li>Claims processing or insurance experience, preferred but not essential.</li><li>Broad awareness of medical terminology, advantageous.</li><li>Excellent organizational skills, capable of following and contributing to agreed procedure.</li><li>Strong administration awareness and experience, essential.</li><li>Strong skills in Microsoft Office applications, essential.</li><li>First class written and verbal communication skills, essential.</li><li>Ability to communicate across a diverse population, essential.</li><li>Capable of working independently, or as part of a team.</li><li>Good time management, ability to work to tight deadlines.</li><li>Flexible and adaptable approach, sometimes working in a fast-paced environment.</li><li>Passion for achieving agreed objectives.</li><li>Confident in calling out when facing issues.</li><li>Should be flexible to work in shifts and on staggered weekends for overtime.</li></ul>COMMUNICATIONS AND WORKING RELATIONSHIPS<h3>The job holder must ensure building strong effective relationships with all his matrix partners and demonstrating approachability and openness. He/ She must be able to foster strong internal and external communication standards.</h3>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.

This job is a Claims Representative role, where you help process medical claims and communicate with providers. You might like this job because it combines problem-solving with detailed work, and you get to support people&#x27;s health journeys daily!

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 ...

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