Claims Senior Representative

JOB DESCRIPTION
Scope

Responsible for the claims verification and end-to-end processing of medical claims, ensuring all cases are handled within the TAT with a strong focus on accuracy, compliance, and high-quality service delivery.

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.

- Technical Proficiency: Strong hands-on experience in Mainframe and Octopus systems, including accurate claims processing, data validation, and navigation across claim workflows; able to quickly adapt to system enhancements and updates.

About The Cigna Group

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.