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DESCRIPTION
Delivers straightforward administrative and/or other basic business services in Claims. Examines and processes paper claims and/or electronic claims. Determines whether to return, pend, deny or pay claims within policies. Determines steps necessary for adjudication. Settles claims with claimants in accordance with policy provisions. Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim. Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries. Issues tend to be routine in nature. Good knowledge and understanding of Claims and business/operating processes and procedures. Works to clearly defined procedures under close supervision.
ABOUT US: Cigna Corporation is a global health service company. We provide healthcare products and services, group disability, life and accident insurance and international insurance– directly to individuals and through employers and intermediaries. Cigna’s mission is to help our customers improve their health, well-being and sense of security.
YOUR MISSION: Critical analysis and processing of claims for medical expenses within the fixed turn around time.
KEY AREAS:
• Claims processing:- Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality.
- Accurate data input to the PC and mainframe applications.
- Positioning himself/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 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:
- Providing accurate communication about a dossier to the interested internal employee.
- Tracking irregularities in procedures and highlighting these to the Supervisor.
- Raising problems or sensitivities with your superior.
- Participating actively in an agreeable and amicable atmosphere.
REQUIREMENTS
SKILLS AND KNOWLEDGE:
• Education Level:- Degree or similar by experience (Foreign languages studies, translation and interpreting, administration, accountancy).
• Specific Knowledge:
-Active knowledge of English & Spanish.
- Good knowledge of German
• 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
- Discreet: works discreetly with confidential (medical) information.