The Cigna Group is Looking for Claims Lead Representative POS at Bangalore Full Time

About Us

At CIGNA Healthcare we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities, and shareholders every day.

One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We are devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being.

CIGNA Healthcare believes both in the importance of working together and offering flexibility to our employees. We use a multi-faceted approach for flexibility, depending on the various roles in our organization.

Working at CIGNA Healthcare will give you a great career with opportunities to learn, grow and make an impact, along with the power to make a difference. Join us!

Process Overview*

• EU insurance claims processing for individual, employer, group, and provider.

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: –

You will be responsible for the timely intake and processing of all incoming cases as well as Guarantee of Payments.

The Guarantee of Payment is a confirmation towards the hospital regarding length of admission, treatment, and insured amount.

• Analyze requests for hospitalization and evaluating treatments, as well as amount and the length of stay depending on policy.

• Act as liaison between medical providers and insured individual, mainly by phone, to obtain all necessary information.

• Review and monitor cases to ensure files are cascaded to appropriate teams, depending on specific identified triggers.

• Act as point of contact for hospitals regarding all questions related to the Guarantee of Payment.

• Negotiate discounts with providers.

• Maintain all necessary information regarding the hospitalizations in an internal database.

• Translate and interpret medical and other relevant documents for case analysis.

• Work independently and effectively to communicate to internal and external customers by telephone and e-mail.

• Maintain accurate workflow and process documentation following outlined processes. Adjudicate international medical/dental and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.

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.

• Business Application: Ability to initiate research, plan, and coordinate.

• Proven ability to build relationships with matrix partners.

• Ability to work and problem solve independently but escalate when needed.

• Convey information clearly to both medical providers, internal partners, and customers.

• Medical Terminology Background

• Customer-focused: works efficiently with internal partners to find best solutions for customers.

• Skilled decision-maker takes the right action on dedicated files based on available information.

• Accuracy: ensures concise and correct information is being delivered.

• Disciplined: follows procedures, agreements and document flows correctly.

• Efficiency: able to strike the right balance between quality and quantity

• Team-player enjoys working as part of a team and building internal networks.

• Computer-literate: quick to learn International in-house systems and use current office applications Excellent critical thinking and decision-making skills. Excellent critical thinking and decision-making skills.

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 pre-authorization flow wrt EU insurance claims processing.

Work Timings : Flexible to work in 247 set-up (includes weekend working and alternate hours in IST, beyond 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.