Claims Senior Representative - Cigna Healthcare

Scope
Critical analysis and processing of claims for medical expenses within the fixed turn around time.

Job content
Claims processing
- Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality.
- Accurate data input to the system applications.
- Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods.
- Following up his/her own workload (volume and timing): keeping an eye on chronology and processing time of the work volume and taking suitable actions.
- Participate efficiently in processing the flow of claims: inform the Claims Supervisor about claims lacking clarity and about possible ways of optimizing the processes.
- A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactions are important motivators.

In relation to other positions
- Act as focal point of contact for cases, questions from other Claims Analysts and following-up on files
- Providing accurate communication about a dossier to the interested internal employee.
- Tracking irregularities in procedures and highlighting these to the Claims Supervisor.
- Raising problems or sensitivities with your superior.
- Coaching and training trainees
- Participating actively in an agreeable and amicable atmosphere.

Additional task
- Financial verification
- Assisting Claims Supervisor, Claims in work planning, implementation of new contract, updating of Contract Summary, conducting refresher trainings
- Work closely with SMEs & Claims Supervisor and identify areas for improvement based on customer feedback on our services.

PROFILE
Education Level
- Bachelor degree or similar by experience
Specific Knowledge
- Passive language knowledge (English, Mandarin etc.)
- Policies coverage
- Medical terminology
- Use of necessary reference works

Skills
- Skillful in taking decisions: takes the right action on allocated files based on the available information.
- Skillful with numbers: likes to work with numbers.
- Accurate: works accurately on the input of data, aims to work faultlessly.
- Discipline: pays attention to procedures, agreements and document flows.
- Efficient: finds a good balance between quality and quantity.
- Team player: Able to work in a team.
- Skillful with computer programs: readily learns the ropes in the use of current office applications and own Cigna International systems.
- Discreet: works discreetly with confidential (medical) information.
- Active knowledge of Tools needed to perform main tasks and responsibilities, such as Microsoft Office applications, CRM and tailor made software.