Claims Representative
at The Cigna Group
Kuala Lumpur, KL, Malaysia -
Start Date | Expiry Date | Salary | Posted On | Experience | Skills | Telecommute | Sponsor Visa |
---|---|---|---|---|---|---|---|
Immediate | 07 Jul, 2024 | Not Specified | 09 Apr, 2024 | 1 year(s) or above | Time Management,Communication Skills,Medical Terminology | No | No |
Required Visa Status:
Citizen | GC |
US Citizen | Student Visa |
H1B | CPT |
OPT | H4 Spouse of H1B |
GC Green Card |
Employment Type:
Full Time | Part Time |
Permanent | Independent - 1099 |
Contract – W2 | C2H Independent |
C2H W2 | Contract – Corp 2 Corp |
Contract to Hire – Corp 2 Corp |
Description:
KNOWLEDGE, SKILLS AND EXPERIENCE
- At least 1-2 years of experience performing a similar role.
- Medically qualified as a doctor.
- Experience of 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, capable of following and contributing to agreed procedure.
- Strong administration awareness and experience, essential.
- Strong skills in Microsoft Office applications, essential.
- First class written and verbal communication skills, essential.
- Ability to communicate across a diverse population, essential.
- Capable of working independently, or as part of a team.
- Good time management, ability to work to tight deadlines.
- Flexible and adaptable approach, sometimes working in a fast-paced environment.
- Passion for achieving agreed objectives.
- Confident in calling out when facing issues.
- Should be flexible to work in shifts and on staggered weekends
Responsibilities:
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 members and providers.
- Assists queries from providers and payers via phone calls or e-mails.
- Maintains files for authorizations and other reports.
- Assesses and processes claims in line with the policy coverage and medical necessity.
- Be fully versed with medical insurance policies for various groups / beneficiaries.
- May assist in training colleagues and asked to share knowledge.
- Accurately assesses eligibility within the policy boundaries.
- Monitors and maintains the claims processing as per the defined terms and policy of the organization.
- Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis.
- Monitors the qualitative and quantitative measures for claims & pre-approvals.
- Ensures compliance to any changes in terms of system parameters or process.
- Maintains quality as per framework for accuracy.
- Maintains productivity and responsiveness to the work allocated.
- Collaborate with other stakeholders / teams to resolve queries including complex queries.
- Actively support all team members to enable operational goals to be achieved.
- Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).
- 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 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 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.
- Monitor and highlight high-cost claims and ensure relevant parties are aware.
- Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and TAT target on claims adjudication.
- Adjust error claims according to actual situation.
- Well handle recoupment and reconciliation work, communicate with providers and members via call and email for collection and explanation.
- Work with cross function teams, such as Finance, CSR, Eligibility, Network, Client Management, etc. Ensure recoupment work go smoothly.
- Actively support Team Leader and work with claim colleagues to enable all operational goals to be achieved
REQUIREMENT SUMMARY
Min:1.0Max:2.0 year(s)
Insurance
Banking / Insurance
Insurance
Graduate
Proficient
1
Kuala Lumpur, Malaysia