Cigna is seeking a Care Associate Analyst to join our clinical team. The successful candidate will be responsible for reviewing and approving medical services requested by providers or customers according to medical necessity review guidelines. This role ensures customers receive high-quality care, diagnostics, and treatment while avoiding over- or under-utilization of clinical services. You will provide medical management services to customers worldwide, with a primary focus on the Africa region.
Key Responsibilities
Medical Necessity Review: Review and approve medical services based on necessity guidelines and provide guidance to clinical and non-clinical staff.
Pre-authorization: Give evidence-based advice on pre-authorization, considering international protocols and regional regulations.
Claims Assessment: Assess pre-authorization requests and claims in line with policy coverage.
Case Management: Identify and refer cases to the Cigna Clinical team for case management and disease management.
Cost Containment: Support the team in cost containment initiatives and projects to meet service delivery goals.
Inquiry Handling: Respond to external and internal inquiries/complaints and assist providers and payers via phone or email.
Fraud Detection: Assist in the detection of fraudulent activities.
Compliance & Performance: Meet qualitative and quantitative key performance metrics (KPIs) and adhere to predefined turnaround times (TATs) for pre-approvals.
Training: Assist in training colleagues and sharing clinical knowledge as required.
Requirements
Education: University Degree or Diploma in a Medical specialization.
Experience: 2-3 years of clinical experience, preferably in a payer (insurance) setting focused on medical management.
Regional Knowledge: Experience in the Africa region and international markets.
Languages: Fluent in English along with proficiency in either French, Portuguese, or Spanish. Additional languages are a plus.
Technical Skills: Computer literate with knowledge of utilization review, cost containment services, and insurance coverage.
Soft Skills: Strong interpersonal and communication skills; proactive problem-solving and analytical abilities.
Work Flexibility: Ability to work under pressure, meet tight deadlines, and work on shifts or varying schedules.
How to Apply
Interested and qualified candidates should apply online via the Cigna career portal. Click the link below to access the application page:
Interested and qualified candidates should apply by visiting the Cigna application portal via the following link: https://www.myjobmag.co.ke/apply-now/1193237. This will redirect you to the official Workday careers page for Cigna.
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