Description
We are seeking a Claim Representative A to join our Claims team at CIGNA Healthcare in Bengaluru, India.
The job holder is responsible for serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining databases.
Responsibilities and Duties
- Process claims from members and providers
- Assist queries from providers and payers via phone calls or emails
- Maintain files for authorizations and other reports
- Assess and process claims in line with policy coverage and medical necessity
- Be fully versed with medical insurance policies for various groups/beneficiaries
- May assist in training colleagues and sharing knowledge
- Accurately assess eligibility within policy boundaries
- Monitor and maintain claims processing as per defined terms and policy
- Achieve required processing targets assigned by the team leader
- Monitor qualitative and quantitative measures for claims and pre-approvals
- Ensure compliance with changes in system parameters or processes
- Maintain quality as per framework for accuracy
- Maintain productivity and responsiveness to allocated work
- Collaborate with other stakeholders/teams to resolve queries
- Actively support team members to enable operational goals
- Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores, and NPS
Requirements
- At least 1-2 years of experience performing a similar role
- Experience working for an international company preferred but not essential
- Claims processing or insurance experience preferred but not essential
- Broad awareness of medical terminology advantageous
- Excellent organizational skills
- Strong administration awareness and experience
- Strong skills in Microsoft Office applications
- First-class written and verbal communication skills
- Ability to communicate across a diverse population
- Capable of working independently or as part of a team
- Good time management and ability to work to tight deadlines
- Flexible and adaptable approach
Work Timings
- 7:30 AM to 4:30 PM IST (flexible shift)
Job Location
- Bengaluru (Bangalore)