Cigna is seeking a Claims Representative to analyze and adjudicate medical, dental, and vision insurance claims. This role involves assessing reimbursements according to policy terms, coding and calculating claims within a computerized system, and ensuring that all processing meets strict quality and productivity standards. The position requires a high degree of accuracy and a focus on customer centricity.
Main Duties / Responsibilities
Analyze medical, dental, and vision claims in accordance with policy terms and conditions.
Adjudicate claims using a computerized processing system, assessing and calculating reimbursements based on contract agreements.
Coordinate with the communication team to resolve or prevent potential issues with stakeholders.
Monitor turnaround times to ensure claims are settled within the required timelines, highlighting issues to supervisors when needed.
Manage complex cases with the necessary accuracy and personal attention.
Stay updated on medical information, policies, and processes through continuous training.
Identify and communicate inaccuracies in files to the team lead or department head.
Respond to inquiries regarding plan design, eligibility, and claim status with an aim for first-call resolution.
Perform other ad-hoc tasks as required to meet business needs.
Requirements and Qualifications
Education: Diploma or degree in a related field (BA/BSc/HND).
Skills: Knowledge of claims processing; proficiency in French is a major advantage.
Aptitude: Strong numerical skills, promptness, and precision.
Experience: Previous experience in analytical work is a plus.
Competencies: Attention to detail, ability to work independently, and a proactive, customer-focused approach.
Technical: Ability to quickly learn and adapt to computer applications and changing work processes.
How to Apply
Interested and qualified candidates should apply online via the Cigna careers portal at: https://www.myjobmag.co.ke/apply-now/1148423. Follow the instructions on the platform to complete your application.
