IOH Member Claims Representative at Cigna

• Job Type Full Time
• Qualification BA/BSc/HND , Diploma
• Experience
• Location Nairobi
• Job Field Insurance
• As Claims Representative you analyze claims in respect of client medical costs.
• You adjudicate medical/dental and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• You analyze reimbursements according to the contract agreements and assess, code and calculate them using a computerized claims processing system.
• You pass communications to the communication team to solve or preempt any possible issues with your stakeholders.
• Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your supervisor when this is not achievable.
• You take responsibility/ownership of complex cases. You handle them accurately and with the personal attention that is required.
• You keep your knowledge up to date with respect to the medical information necessary for handling claims and you take part in trainings to ensure you are up to date with policies, processes and other required information.
• You are attentive to inaccuracies in the files and communicate them to your team leader/departmental head.
• Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first call resolution where possible.
• Carry out other adhoc tasks as required in meeting business needs.
• Diploma or degree in a relevant field.
• Previous experience handling medical claims within a health insurance or healthcare provider environment is an added advantage.
• Strong working knowledge of English, with confidence communicating with both internal and external stakeholders.
• French language proficiency is an added advantage.
• Previous experience in an analytical role with strong numerical ability with a high level of accuracy and attention to detail is desirable.
• Good analytical and problem-solving skills, with the ability to review information and make sound decisions.
• Customer-focused mindset, with the ability to balance accuracy, service and operational requirements.
• Ability to work independently, take ownership of tasks and escalate appropriately when required.
• Ability to adapt quickly to changing processes, priorities and systems.
• High level of integrity and discretion when handling confidential and sensitive medical or customer information.
• Proactive and collaborative approach, with a willingness to share knowledge and best practices with colleagues.
• Comfortable learning and working with computer-based applications and claims processing systems.