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Provider Reconciliation Claims Representative

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This job is for a Provider Reconciliation Claims Representative. You'll review and investigate medical claims, communicate with providers globally, and suggest process improvements. You might like this job because of the opportunity to work in an emerging department of an international enterprise with attractive salary conditions and benefits.

Undisclosed

Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia, Kuala Lumpur

Job Description

YOUR JOB

As a Provider Reconciliation Agent you will be part of a Global Provider Reconciliation (GPR) Team  embedded into the Provider Services department. Your main reponsabilities wil be related with review of the reconciliation requests from providers on the paid medical claims where you would need to investigate the status of a certain bill using Cigna relevant payment systems. For some specific cases you would be in contact with different departments within Cigna to take necessary steps in order to resolve the reconcialition cases according to the established timeframe. Apart from this you will be monitoring the incoming/outgoing communications with our globally distributed medical facilities as well as be a point of contact for other departments with any provider claims related quiries.

Your role includes

  • You will be repsonsible for the initial review of the reconciliation requests  received from providers using relevant supporting systems;
  • Performing deeper investigation on certain cases together with further coordination with other teams in order to solve the cases according to the established standards;
  • As part of the reconciliation review, you will be following up on the cases where additional support is needed to help the facility interprete our feedback and take necessary steps;
  • Managing the incoming and outgoing communications with our providers globally and handling the internal requests related to provider inquiries;
  • Performing the intake process of the reconciliation cases which will include upload, priority setting and close follow up on the completion;
  • Actively support other GPR team members and provide help to enable team goals to be achieved;
  • Being able to identify any process improvement and make recommendations for potential changes;
  • Provide feedback to the GPR team on urgent or critical cases that need special action or attention;
  • Processing claims and adjustments as an outcome of the reconciliation.

YOUR PROFILE

  • At least 1 years of experience in a customer service role;
  • Good Engllish language skills, additional language is a plus;
  • International mind-set able to work remotely with colleagues, partners and providers across the globe;
  • Striving for excellent service to our members, clients and providers is part of your DNA;
  • Detail oriented with high accuracy level and proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards);
  • Act with a sense of urgency to research questions or issues brought by different teams. Identify the right parties or resources to resolve these issues;
  • Strong customer focus with ability to identify and solve problems;
  • Strong interpersonal skills with good verbal and written communication to internal and external parties;
  • Be a positive role model and have the ability to work independently and in conjunction with co-workers of all levels.
  • A growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives.
  • Accountability – to assume ownership for achieving personal results and to contribute for collective team goals;
  • Working knowledge of SharePoint & Microsoft office;

This role is reporting directly to the Global Provider Reconciliation Senior Supervisor, based in Madrid, Europe.

OUR OFFER

  • A challenging job in an emerging Department within and international and growing enterprise.
  • A dynamic, young and entrepreneurial company culture that values and stimulates initiative.
  • Attractive salary conditions with benefits package

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.


Job Requirements


Company Benefits

Rewards & time away

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

Medical benefit

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

Dental & vision

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

Financial support

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


Additional Info

Company Activity

Last active - few hours ago


Company Profile

The Cigna Group-logo-image

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: thecignagroup.com