Claims Representative - IOH Member Claims

We are looking for a detail-oriented Claims Representative to join our claims team. You will be responsible for verifying information and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

To be successful as a claim’s processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.

Main Duties / Responsibilities

• 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.

Claims Processor Requirements:

• Knowledge in claims processing
• French language is an added advantage.
• Diploma or degree in a related field.
• You are prompt, precise and good with numbers.
• A first experience in analytical work is a plus.
• You have an eye for detail and you are known to work meticulously.
• You can work individually and make correct decisions, always keeping customer centricity as guiding principle through everyday work.
• You are flexible and quickly adapt to ever-changing work processes.
• You are aware of the sensitivity and delicacy of the information you handle.
• You are proactive, ensuring a smooth workflow and taking into account the needs of your client.
• You are a team-player, sharing best practices on processes and procedures with your colleagues.
• You can familiarize yourself quickly with computer applications.

About Cigna Healthcare

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. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.