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  • Customer Service Representative Portuguese Speaker Customer Service Representative – Chinese Speaker

    Customer Service Representative Portuguese Speaker Customer Service Representative – Chinese Speaker

    About the job

    You are responsible for the client communication for designated account relationships and Contracts.
    You are required to response to the client on timely manner providing full and accurate information in one go.

    Main Duties / Responsibilities

    Handle calls and e-mails and respond to simple and complex inquiries regarding eligibility, cards status, envoy registration/navigation, policy benefits, issue certificates of insurance, claims status and other related information and provide solutions for customers and clients.
    Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, clients, brokers and/or others.
    Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
    Mails or routes claim forms and supporting documentation to various units for final processing.
    Excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
    May seek assistance with complex customer services issues.

    Qualifications

    Must have a diploma or bachelor’s degree or equivalent
    Excellent English written and oral communication skills
    Portuguese written and oral skill is a must
    Exceptional organizational and time-management focus
    Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
    1+ years of customer service experience analyzing and solving customer problems required; call center experience a plus
    Ability to perform in a high volume, fast paced call center environment
    Proven ability to work independently as well as a productive member of a team
    Intermediate proficiency in Microsoft office suite; high level capacity to multitask independently and on a computer
    Knowledge of medical terminology a plus

    Conditions/requirements

    Work in 24 x 7 rotation shifts.
    5 days a week.
    In split shifts (some hours in the morning and remaining hours in the afternoon or evening) and public holidays

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    Use the link(s) below to apply on company website.  

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  • Customer Service Representative Portuguese Speaker Customer Service Representative – Chinese Speaker Provider Intake General Clerk Associate Representative

    Customer Service Representative Portuguese Speaker Customer Service Representative – Chinese Speaker Provider Intake General Clerk Associate Representative

    About the job

    You are responsible for the client communication for designated account relationships and Contracts.
    You are required to response to the client on timely manner providing full and accurate information in one go.

    Main Duties / Responsibilities

    Handle calls and e-mails and respond to simple and complex inquiries regarding eligibility, cards status, envoy registration/navigation, policy benefits, issue certificates of insurance, claims status and other related information and provide solutions for customers and clients.
    Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, clients, brokers and/or others.
    Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
    Mails or routes claim forms and supporting documentation to various units for final processing.
    Excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
    May seek assistance with complex customer services issues.

    Qualifications

    Must have a diploma or bachelor’s degree or equivalent
    Excellent English written and oral communication skills
    Portuguese written and oral skill is a must
    Exceptional organizational and time-management focus
    Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
    1+ years of customer service experience analyzing and solving customer problems required; call center experience a plus
    Ability to perform in a high volume, fast paced call center environment
    Proven ability to work independently as well as a productive member of a team
    Intermediate proficiency in Microsoft office suite; high level capacity to multitask independently and on a computer
    Knowledge of medical terminology a plus

    Conditions/requirements

    Work in 24 x 7 rotation shifts.
    5 days a week.
    In split shifts (some hours in the morning and remaining hours in the afternoon or evening) and public holidays

    go to method of application »

    Use the link(s) below to apply on company website.  

    Apply via :

  • Fraud Analyst – Payment Integrity

    Fraud Analyst – Payment Integrity

    Role Summary:

    As Fraud Analyst within Payment Integrity Team you will be directly supporting Cigna’s affordability commitment within Cigna International’s business. This role is responsible for detecting and recovering FWA payments, creating solutions to prevent claims overpayment and future spend monitoring within a dedicated region. Will work closely with other Payment Integrity team members, Network, Data & Analytics, Claims Operations, Clinical partners, Product and Member Investigation Unit (MIU).

    Responsibilities:

    Identify and investigate potential instances of fraud, waste or abuse (FWA) across all Cigna’s International Markets books of business for claims incurred in a dedicated region (Middle East & Africa).
    Seek recovery of FWA payments from claim submissions.
    Ensure PI savings are tracked and reported accurately.
    Work in partnership to implement solutions and drive execution to prevent claims overpayment, unnecessary claim spend, and ensure timeliness and accuracy of PI claims review process.
    Negotiation with providers contracted by Cigna or out-of-Network providers.
    Perform data-mining to reveal FWA trends and patterns.
    Collaborate with the Special Investigation Unit on Fraud cases.
    Partner with Cigna TPAs on FWA investigations.
    Partner with Payment Integrity teams in other locations to share FWA claiming schemes.
    Partner with Data Analytics team in building future FWA triggers automation.
    Provide investigation reports to internal and external stakeholders.

    Skills and Requirements:

    You should enjoy working in a team of high performers, who hold each other accountable to perform to their very best.
    Experience of investigation within payment integrity or similar discipline.
    Minimum of 4 years of health insurance or health care provider experience.
    Knowledge of International Health claim platforms essential.
    Knowledge of claims coding, regulatory rules and medical policy.
    Medical/ paramedical qualification is a definite plus.
    Critical mind-set with ability to identify cost containment opportunities.
    Experience with data analytics
    Demonstrated strong organization skills.
    Strong attention to detail.
    Ability to quickly learn new and complex tasks and concepts.
    Excellent verbal and written communication skills.
    Ability to balance multiple priorities at once and deliver on tight timelines.
    Flexibility to work with global teams and varying time zones effectively.
    Experience in liaising with internal stakeholders and ability to work independently within a cross functional team.
    Strong organization skills with the ability to juggle priorities and work under pressure to meet tight deadlines.
    Fluency in foreign languages in addition to fluent English is a strong plus.

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Medical Claims Representative

    Medical Claims Representative

    Main Duties / Responsibilities

    A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
    Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
    In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
    Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
    Recording and maintaining insurance policy and claims information in a database system.
    Determining policy coverage and calculating claim amounts.
    Processing claims payments.
    Answering queries related to Policy coverage criteria and guidelines.
    Complying with federal, state, and company regulations and policies.
    Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
    Good communication skills are necessary to converse with doctors’ offices or insurance companies if there is a problem with the claim.
    Performing other clerical tasks, as required.

    Claims Processor Requirements:

    Medical Qualification Background will be an added advantage.
    At least 2 years of experience as a claim’s processor or in a related role.
    Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.
    Working knowledge of the insurance industry and relevant federal and state regulations.
    Computer literate and proficient in MS Office.
    Excellent critical thinking and decision-making skills.
    Good administrative and organizational skills.
    Strong customer service skills.
    Ability to work under pressure.
    High attention to details

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Operations Representative – LPS

    Operations Representative – LPS

    Your job at Cigna

    For this Customer Service Representative (CSR) role, we are looking to expand the Life & Protection Solutions team.
    Your role will include specialised tasks: process incoming insurance claims (travel, temporary working incapacity), be the first point of contact for the insurance policyholders, and manage reporting data to internal and external parties.
    CSRs are supported by the people manager, a technical expert and the fellow team members.

    Daily tasks include:

    Assessing and processing incoming claims based on the policy conditions. You are the hub between different parties, such as medical advisors, the claimants, the claimant’s HR department, etc., and ensure the claim is handled completely and correctly.
    Managing the working-incapacity overviews of insured organisations (clients). You cultivate a professional relationship with the clients and third parties. You handle files in a way that best serves the interests of claimants and clients.
    Filling out data about claims accurately and reporting it to the necessary parties, such as the finance department, client managers or a client.
    Answering general questions about policy conditions per email and over the phone in multiple languages.

    Profile

    A bachelor’s degree or higher in a related study field (finance, insurance, communication) or equivalent through experience.
    Fluent in English and one of the following: French / German / Dutch.
    Previous experience with non-medical claims such as life insurance or travel insurance is a bonus.
    Eager to learn and adaptable.
    Customer centric and responsible.
    Results-oriented and analytical.
    Able to work independently and together with others in a team.
    A good knowledge of the Office package (Word, Excel, Outlook) that we can build on depending on need.

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Intake Care Associate Analyst

    Intake Care Associate Analyst

    JOB DESCRIPTION

    You will be responsible for the timely intake and processing of all incoming cases as well as Guarantee of Payments.
    The Guarantee of Payment is a confirmation towards the hospital regarding length of admission, treatment, and insured amount
    Analyze requests for hospitalization and evaluating treatments, as well as amount and the length of stay depending on policy
    Act as liaison between medical providers and insured individual, mainly by phone, to obtain all necessary information
    Review and monitor cases to ensure files are cascaded to appropriate teams, depending on specific identified triggers
    Act as point of contact for hospitals regarding all questions related to the Guarantee of Payment
    Negotiate discounts with providers
    Maintain all necessary information regarding the hospitalizations in an internal database
    Translate and interpret medical and other relevant documents for case analysis
    Work independently and effectively to communicate to internal and external customers by telephone and e-mail
    Maintain accurate workflow and process documentation following outlined processes

    Qualifications

    Diploma or Bachelors degree required
    1-2 years of experience in a customer service or claims environment
    Experience in healthcare operations background preferred
    Ability to speak, write and read English, any other language a plus
    Business Application: Ability to initiate research, plan and coordinate 
    Proven ability to build relationships with matrix partners
    Ability to work and problem solve independently but escalate when needed  
    Convey information clearly to both medical providers, internal partners, and customers
    Medical Terminology Background
    Must be comfortable to work permanently on night shift (working from home).

    Competencies

    Customer-focused: works efficiently with internal partners to find best solutions for customers
    Skilled decision-maker: takes the right action on dedicated files based on available  information
    Accuracy: ensures concise and correct information is being delivered
    Disciplined: follows procedures, agreements and document flows correctly.
    Efficiency: able to strike the right balance between quality and quantity
    Team-player: enjoys working as part of a team and building internal networks
    Computer-literate: quick to learn International in-house systems and use current office applications

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Provider Inquiry Coordinator – French Speaking

    Provider Inquiry Coordinator – French Speaking

    Job Description Summary

    Delivers best in class service to HCP by handling daily queries, escalations, complaints, reconciliations and suspensions. Analyses root causes in order to correct deviations and implement initiatives to improve service delivery. Closely collaborates with provider network team and other key stakeholders to coordinate actions, projects and improvement plans aimed to improve member and provider experience.

    Job Description

    As a Provider Inquiry Coordinator (PIC) you will be part of Provider Relations Team embedded into the Provider Services Organization, being responsible for escalation, reconciliation, relationship, and suspension management with Health Care Providers. 

    You will be in charge of the communication of the outcome to the facilities, support them in interpreting the feedback received from Cigna and close follow up on the further actions needed.  You will work very closely with your peers and the rest of Provider Services Organization across the globe. 

    Your role includes:

    Responsible to enable an effective and efficient collaboration with health providers through monitoring and analysing the results of the reconciliation of the accounts fulfilled by the Provider Reconciliation team and other Operational KPIs;  
    Comprehensive support on their interpretation and assurance of further follow up if needed. 
    Conduct regular root cause analysis and consolidated feedback of the data obtained out of the Reconciliation outcome or other sources, striving for continuous service delivery improvement through BAU collaboration with different teams;
    Active communication and prompt follow up combined with regular meetings with your dedicated health care providers.
    Participation in coordination sessions with Network and Operations teams seeking for better practices in order to prevent service deficiencies and assure 5 star experience to health care providers;
    Being a person of contact for providers and stakeholders in regards of Operational issues / queries within the IHDS organization
    Support the PR Team to determine short and middle term solutions for smooth reconciliation process with Providers by continuously analysing the intake of queries and complaints, as well as conducting reviews of the current processes for potential improvements.
    Consolidated feedback to PR Team striving for continuous service delivery improvement through BAU collaboration with different teams.
    Deliver on operational KPI’s within the PR team in terms of production, quality, TAT, suspensions and provider NPS.

    Your Profile

    Internal Candidates: 2 years of Cigna experience, relevant experience in other functions/companies, and a strong performance track record.
    External Candidates: At least 2 years of experience in Operations, Data analysis, Marketing/Communications or Relationship Management, with operational and customer/provider-facing experience profile.
    Proficient in English, additional language required (French is a must)
    Strong analytical and problem-solving skills.
    International mind-set able to work remotely with colleagues, partners and providers across the globe.
    Striving for excellent service to our members, clients and providers is part of your DNA.
    Detail oriented
    Ability to engage in multiple tasks and meet deadlines.
    Act with a sense of urgency to research questions or issues brought by different teams. Identify the right parties or resources to resolve these issues.
    Ability to assess the situation/issue, carry out appropriate research, gather the relevant data and provide constructive feedback on the outcome.
    Excellent communication skills – verbal, written and presentation. 
    Be a positive role model and have the ability to work independently and in conjunction with co-workers of all levels.
    Strong practical knowledge of MS Office applications (Advanced Excel Skills preferred).

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Operations Representative – French/German/Dutch Language Required

    Operations Representative – French/German/Dutch Language Required

    Your job at Cigna

    For this Customer Service Representative (CSR) role, we are looking to expand the Life & Protection Solutions team. Your role will include specialised tasks: process incoming insurance claims (travel, temporary working incapacity), be the first point of contact for the insurance policyholders, and manage reporting data to internal and external parties.

    CSRs are supported by the people manager, a technical expert and the fellow team members.

    Daily tasks include:

    Assessing and processing incoming claims based on the policy conditions. You are the hub between different parties, such as medical advisors, the claimants, the claimant’s HR department, etc., and ensure the claim is handled completely and correctly.
    Managing the working-incapacity overviews of insured organisations (clients). You cultivate a professional relationship with the clients and third parties. You handle files in a way that best serves the interests of claimants and clients.
    Filling out data about claims accurately and reporting it to the necessary parties, such as the finance department, client managers or a client.
    Answering general questions about policy conditions per email and over the phone in multiple languages.

    Profile

    A bachelor’s degree or higher in a related study field (finance, insurance, communication) or equivalent through experience.
    Fluent in English and one of the following: French / German / Dutch.
    Previous experience with non-medical claims such as life insurance or travel insurance is a bonus.
    Eager to learn and adaptable.
    Customer centric and responsible.
    Results-oriented and analytical.
    Able to work independently and together with others in a team.
    A good knowledge of the Office package (Word, Excel, Outlook) that we can build on depending on need.

    Our offer at Cigna

    A diverse job in an international context with impressive clients.
    A welcoming, diligent team and enthused people manager to show you the ropes.
    Cigna’s “Happy You”: health and wellbeing initiatives, flexible work hours, home working opportunities.
    An attractive salary and extra-legal benefits

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Quality Review and Audit Prepay Supervisor

    Quality Review and Audit Prepay Supervisor

    Role Summary:
    As a Quality Review & Audit Supervisor within the Payment Integrity Pre-Payment Team you will be directly supporting Cigna’s affordability commitment within Cigna International’s business. This role is responsible for leading remote, regionally focused prepayment team members who are responsible for identifying and preventing fraudulent, wasteful and abusive expenses within Cigna’s International Business Market. He/ She will work closely with other PI team members, Network, Medical Economics, Data Analytics, Claims Operations, Clinical partners, and Member Investigations Unit (MIU).
    Responsibilities:

    Lead the Regional Prepayment team who are responsible for identifying claims that should not be paid as received and identify claims with potential Fraud, Waste and Abuse savings to meet Provider Integrity targets and KPIs.
    Works closely with Payment Integrity management to understand strategy and is responsible for executing departmental plans and priorities.
    Accountable for managing internal stakeholder relationships.
    Coach and support all PI Pre-Payment team members to monitor and identify non-compliance in billing and claims payment activity within the international markets.
    Ensure department KPIs are met through effective monitoring and reporting mechanisms; ensure PI savings are tracked and reported accurately.
    Executes strategic initiatives, plans, and goals in alignment with department KPIs and financial targets.
    Ensures payment integrity processes are in compliance with legal, regulatory and contractual requirements.
    Assess work demand against capacity to ensure optimum claim referrals across all referral routes; create solutions, drive execution and ensure timeliness and accuracy of PI claims review process.
    Instils work culture of continuous process improvement, innovation, and quality.
    Oversee departmental personnel matters; evaluating staff performance and conducting performance appraisals for all direct reports. Ensure adherence to company practices and procedures.
    Assist in organizing the on-boarding and training of new hires to the team.
    Perform verification of services and charges and in some cases negotiate with providers contracted by Cigna or out-of-Network providers.
    Recommends changes in policy and procedures in order to mitigate risk and participates in projects to improve business protocols.
    Provides input into workforce planning and recruitment activities and addresses resource and operational challenges. 
    Providing feedback to other departments in order to put in place safeguards to prevent further risk exposure
    Working closely with other departments to ensure Payment Integrity activities do not have an unnecessary negative impact on our customers.

    Skills and Requirements:

    Demonstrated strong organization skills
    Strong attention to detail
    Ability to quickly learn new and complex tasks and concepts
    Competent in processing or investigating claims on either the GlobalCare and or Actisure claim platforms
    Minimum of 2 years of health insurance or international health care provider experience.
    Minimum of 1 year of experience work in a Payment Integrity function preferred
    Fluency in foreign languages in addition to fluent English is a strong plus
    Knowledge of medical terminology and treatment modalities is a plus.
    Data analysis and reporting skills preferred
    Inquisitive nature capable of thinking critically and challenging assumptions
    Demonstrated follow through on complex problems and tasks
    Comfortable working independently and with a team
    Flexibility to work with global teams and varying time zones effectively.
    Ability to balance multiple priorities at once and deliver on tight timelines
    Ability to stay up to date on operations workflows
    Ability to develop and effectively communicate presentations and training materials
    Strong written and verbal communication skills
    Patience and creativity amongst your strong points
    Proficiency with Microsoft Excel needed. Word, PowerPoint, Outlook,  and SharePoint preferred
    Experience processing international claims preferred
    Comfort with telephonic outreaches to global entities preferred

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Nurse Case Manager – Portuguese or French Required Customer Service Representative – Portuguese/Arabic/Chinese Required

    Nurse Case Manager – Portuguese or French Required Customer Service Representative – Portuguese/Arabic/Chinese Required

    Major Responsibilities

    Manages an active caseload of case management cases for Cigna and provides one on one case management to customers to improve health status, reduce health risks and improve quality of life.
    Uses clinical knowledge and Cigna approved guidelines and tools to assess diagnosis and treatment plans and goals and identifies gaps in care or risks for readmission or complications.
    Works with a multicultural population and is constantly aware of the cultural differences among that population.
    Establishes patient centric goals and interventions to meet the member’s needs
    Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
    Delivers clinical programs including case management, chronic condition management, hospital support program, etc.
    Balances business needs with patient advocacy
    Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
    Visit providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.
    Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
    Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
    Coordinate care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations
    Maintains accurate workflow and process documents
    Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
    Serve as clinical liaison to Clients
    Other duties as assigned

    Requirements

    Bachelor’s in nursing, 3-5 years of experience in international clinical management
    Experience in the Africa region & International market
    Fluent in English along with either Portuguese or French required
    Demonstrated organizational and leadership skills
    Strong interpersonal and communication skills
    Demonstrates problem-solving and analytical skills.
    Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements
    Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
    Experience with clinical guidelines solutions such as coverage policy and MCG guidelines
    Ability to build solid working relationships with staff, matrix partners, customers and providers
    Flexible to work on shifts/varying work schedules.

    go to method of application »

    Use the link(s) below to apply on company website.  

    Apply via :