Jobs Kenya

Company Address: Address Antwerpen

  • Nurse Case Manager – Portuguese or French

    Nurse Case Manager – Portuguese or French

    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 assigne

    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.

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Customer Service Representative – Portuguese/Arabic/Chinese Nurse Case Manager – Africa Billing Analyst Africa Business

    Customer Service Representative – Portuguese/Arabic/Chinese Nurse Case Manager – Africa Billing Analyst Africa Business

    What are your main responsibilities?

    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.

    KEY AREAS:

    Communication management in day-to-day queries of our clients and insurers through different channels (Email, Phone, Letter and Chat). The main communication channel will be Emails and Calls.
    As a Hybrid team, you require to manage customer interactions through Emails and Calls at the same time.  You require to multitask between both channels based on Email and Call inflow and based on the requirements in the daily planning.
    Think about and contribute to using the most efficient communication channels (phone, e-mail, letter)
    Coordinate and ensure follow-ups of the assigned contracts/clients.
    Answering call from client and advising on the necessary information. To log call in the system and respond via email immediately over the call instead of assigning the task back to the queue.
    Follow up on personal queue for the cases where we received reply.
    Taking ownership on the emails assigned and to complete the necessary before end of business.
    Monitoring Queue to see if there is any queued call which require to be answered instead of allowing the call to drop or abandon.
    Check on medical reports submitted by client and see if we can approve Initial Letter of Guarantee to the provider.
    Check if the complete Reimbursement documents has been submitted before assigning case to Claims Team.
    Keep records and filing up to date.
    Pro-actively optimising the unit’s workflows to achieve set targets.
    Translate communications, medical reports or other documents if needed.
    Work according to the priorities indicated in the work plan and in order to keep under track the different KPIs (ASA, TAT, NPS, etc)
    Able to handle complaints and analyze them, identifying root causes that might lead to the improvement of customer satisfaction

    Qualifications

    Advance or bilingual knowledge of English is a must (C1/C2)
    Advance knowledge of one or more of these languages: Portuguese, Arabic, Chinese, German, French, Spanish (C1 Level).
    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 is 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 :

  • Customer Service Representative – GEH

    Customer Service Representative – GEH

    The Role & Responsibilities:
    We are currently looking for a customer service representative (CSR) to join our young and dynamic team. The responsibilities of the role include (but are not limited to):

    Managing day to day queries from Cigna’s customers whilst putting the service experience at the center of all activities.
    Adhering to the productivity and quality standards set by the management team.
    Taking full ownership of all cases and following through up to the end. When required, scheduling follow-ups to keep the customer in the know regarding the progress of their query.
    Keeping comprehensive records of all customer interactions in the customer relationship management (CRM) tool.
    Handling and processing of medical reports and other highly confidential information in line with all relevant data privacy guidelines (GDPR in particular).
    Obtaining & maintaining expert knowledge about all relevant tools, processes and documentations, but seeking advice from supervisors and higher management when needed.
    Liaising with other department where required for the resolution of a query (claims analysts, medical advisers, finance department etc.).
    In case you speak foreign languages, communicating with our customers in those specific languages (including the occasional translation of documents).

    What we are looking for:
    Education & Work experience:

    Bachelor or experience equivalence.
    Previous Customer Service Experience desired (ideally Contact Center, Reception or similar).
    Good knowledge of MS Office and ability to learn new software applications quickly.
    Good and active knowledge of other languages is a plus.

    Other skills and characteristics of a successful candidate:

    Decision-making ability: Quickly understands new situations and takes the right decisions for a fast and accurate resolution of incoming requests. Ability to navigate ambiguity.
    Communication: Excellent Communication skills both with colleagues and external customers. The ability to emotionally connect with customer in distress is highly desirable.
    Accuracy: High attention to details and a desire to work faultlessly.
    Efficiency: Ability to work quickly through customer requests maintaining high quality standards.
    Team player: Embraces and promotes a co-operative and friendly work-environment in an international and inclusive team.
    Discreet: works discreetly with confidential (medical) information.
    High resilience to work under pressure & the ability to multi-task.

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Care Associate Analyst

    Care Associate Analyst

    Role Purpose
    Responsible to review and approve medical services requested by providers or customers according to medical necessity review guidelines. Will ensure customers receive the best quality care, diagnostics and treatment and avoid over or under-utilization of clinical services. Ability to review, investigate and respond to external and internal inquiries/complaints. Provide guidance to other clinical and non-clinical staff related to medical necessity.
    MAJOR RESPONSIBILITIES

    Assess and process medical approvals using the company system in accordance with conditions & terms of medical policies.
    Give evidence-based advice on preauthorization and medical claims considering internationally accepted protocols and local and or regional customs and regulations. Will use Cigna coverage policy and MCG guidelines.
    Identify and refer cases to the clinical programs team for case management, disease management and other clinical services and assure quality of performance against QA standards to promote optimal service delivery. Give appropriate corrective action if necessary.
    To assist queries from providers and payers via phone calls or e-mails.
    Ensure that hospitals worldwide receive expertise advisory and all necessary documents for a plan member’s admission within the best possible terms.
    Undertaking of hospital admission approvals and declines.
    Ensure appropriate Turnaround Time is adhered to in issuing inpatient and outpatient guarantee of payment approvals.
    Seeking medical clarifications including medical reports, copies of investigation reports, etc.
    Maintain relations by communicating all necessary admission guarantee of payment decisions on a timely basis.
    Ensuring guarantee of payments undertakings are issued in line with the policy provisions. Likewise for declines, ensuring that the decisions are accurate and a correct interpretation of the policy.
    Work with the provider claims reviewers for inpatient claims and coordinating on any information noted in the inpatient claim submitted especially in cases where further information provided changes the position undertaken previously on the claim.
    Interacting with clients, brokers and clinicians as needed, to resolve problems in a manner that is legal, ethical, and consistent with the principles of the policy.
    Checking and confirming membership validity and benefits from policy documents.
    Vetting and confirming validity of the service given by the service provider in relation to the benefits covered, treatment given, adherence to provider panel rules and cost of treatment.
    Obtaining additional required information on claims from providers, brokers, or clients.
    Liaising with our eligibility section on scope of cover for various contracts.
    Training new colleagues in the team.
    You organize the in- and outflow of all incoming communication with special attention to the quality of the messages and to the response turnaround times.
    All of these tasks are performed in English or other languages. French, Portuguese or Spanish an added advantage.

    YOUR PROFILE

    Medical degree or Nursing degree with healthcare/insurance experience.
    Insurance Professional qualification a plus
    Proficient in the use of Microsoft Office Suite and packages Relevant Experience
    You have 2-3 years of clinical experience preferably in a hospital setup or insurance medical management, case management, disease management programs and tools are an advantage.
    You have knowledge of utilization, cost containment services, and insurance coverage.
    You are flexible to work on shifts/varying work schedules.
    You work accurately and have ability to work under pressure and meet tight deadlines.
    You are strong in communication.
    You are service-minded.
    You have a strong sense of responsibility.
    You can easily handle procedures regarding document verification.
    You can easily work with several software applications simultaneously
    You are analytical and like taking initiative
    You handle confidential information in a discrete manner.
    You work autonomously but also enjoy working as part of a team.

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Intake Care Representative

    Intake Care Representative

    KEY AREAS:

    Processes Guarantee of Payments (GOPs) and takes ownership of cases as required. The Guarantee of Payment is a confirmation towards the hospital regarding length of admission, treatment and insured amount.
    Works on sensitive/escalated cases as required. 
    Follows established departmental policies and procedures to process & triage GOPs. 
    Liaises with hospitals in case additional info is needed.
    Negotiates discounts with providers. 
    Steers member to alternative providers.
    Liaises and ensures efficient coordination with the medical/case management teams.
    Works independently and effectively communicate to internal and external customers by telephone and email.
    Maintains accurate workflow and process documents.
    Translates and interprets medical and other relevant documents when needed.

    SKILLS:

    Advance or bilingual knowledge of English is a must (C1/C2)
    Advance knowledge of one or more of these languages: French, German, Portuguese or any other European language (C1 Level).

    What you’ll bring:

    Customer focused with ability to identify and solve problems.
    Customer centric mind-set.
    Exceptional interpersonal skills with good verbal and written communication.
    Ability to organise, prioritise and manage workload to meet individual and team targets.
    Ability to quickly identify customer needs and exercise judgment in a professional and confident manner.
    Must possess excellent attention to detail, with a high level of accuracy with proactive approach.
    Capable of balancing various tasks at once while achieving deadlines.
    Ability to work under own initiative and proactive in recommending and implementing process improvements.

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • PSO Claims Representative

    PSO Claims Representative

    YOUR JOB
    As a Claims Representative you will be handling multiplatform processing and adjusting of claims. You will report directly into the supervisor and will work closely with your peers in the same as well as others locations across the globe. Key to the role will be critical analysis, processing and adjusting of claims for medical expenses within the fixed turn-around time and with high the established quality standards. Your role includes:
    Job Profile:
    Claims processing

    Assessing, processing and adjusting of claims for medical expenses while always bearing in mind the importance of medical confidentiality.
    Accurate data input to the different systems 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 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 supervisor.
    Participating actively in an agreeable and amicable atmosphere.
    Any other duty as assigned by the supervisor.

    YOUR PROFILE/SKILLS
    Education Level

    Bachelor Degree or similar by experience

    Specific Knowledge

    Active knowledge of English
    Active/passive knowledge of other languages is an added advantage (French, Portuguese, Spanish, German, Arabic languages)

    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.
    Flexible: is able to adapt to the changes easily;
    Multitasking: works easily in different systems at the same time;
    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.

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Customer Service Representative

    Customer Service Representative

    KEY AREAS:

    Communication management in day to day queries of our clients and insurers through different channels (Email, Phone, Letter and Chat). The main communication channel will be emails and calls.
    As a Hybrid team, you require to manage customer interactions through emails and calls at the same time. You require to multitask between both channels based on email and call inflow and based on the requirements in the daily planning.
    Think about and contribute to using the most efficient communication channels (phone, e-mail, letter)
    Coordinate and ensure follow-ups of the assigned contracts/clients.
    Answering call from client and advising on the necessary information. To log call in the system and respond via email immediately over the call instead of assigning the task back to the queue.
    Follow up on personal queue for the cases where we received reply.
    Taking ownership on the emails assigned and to complete the necessary before end of business.
    Monitoring queue to see if there is any queued call which require to be answered instead of allowing the call to drop or abandon.
    Check on medical reports submitted by client and see if we can approve Initial Letter of Guarantee to the provider.
    Check if the complete reimbursement documents has been submitted before assigning case to Claims Team.
    Keep records and filing up to date.
    Pro-actively optimizing the unit’s workflows to achieve set targets.
    Translate communications, medical reports or other documents if needed.
    Work according to the priorities indicated in the work plan and in order to keep under track the different KPIs (ASA, TAT, NPS, etc)
    Able to handle complaints and analyze them, identifying root causes that might lead to the improvement of customer satisfaction.

    What skills do you need?​
    Education Level:

    Bachelor or similar by experience: Translation and Interpreting or Foreign Languages studies highly valued.

    Specific Knowledge:

    Minimum One year or more experience in a Customer Service or any related field.
    Handling calls and responding to client on free text email basis.
    Primary language is English.
    French, Spanish, Portuguese speakers would be an added advantage.

    Soft Skills:

    Skillful in taking decisions: takes the right action on allocated files based on the available information and providing the decision in written to client ensuring all relevant information is clear.
    Excellent Communication skills.
    Accurate: works accurately when providing information to client via written email.
    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 and provide feedback on how to improve from time to time.
    Skillful with computer programs: readily learns the ropes in the use of current office applications
    Discreet: works discreetly with confidential (medical) information.

    Working Requirement:

    Able to work in rotational shift hours during weekdays and weekends and public holidays.
    Shift Rotation Monday till Sunday, 5 days a week, 9 hours a day.
    Shift will be a 9 hour day between the hours of 6am and 3am Nairobi time.
    5 days work and 2 days OFF over period of a week.
    Willing to volunteer for overtime during off days and after working hours.
    Able to work from home and from office.
    High speed dedicated Wi-Fi Connection at home (Compulsory)

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Quality Review and Audit Analyst – Payment Integrity

    Quality Review and Audit Analyst – Payment Integrity

    Your responsibilities will include:

    Identifying and preventing fraudulent, wasteful and abusive expenses from around the globe
    Perform a variety of prepay focused cost avoidance activities including:
    Identifying suspicious activity and submission to the designated FWA and SIU team for investigation
    Identifying internal operational errors to prevent incorrect payment being made
    Electronic outreaches to providers requesting documents and confirming information
    Occasional telephonic outreach to providers in local region to negotiate savings
    Verification of charges and services
    Partner with other areas within Payment Integrity to share best practices
    Analyze data on prior payments to identify additional opportunities
    Participate in projects to improve business processes
    Working collaboratively in a team environment to efficiently utilize each individual’s strengths
    Working closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers
    Providing feedback to other departments in order to put in place safeguards to prevent further risk exposure

    Qualifications

    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 Mainframe, Diamond or GlobalCare claim platforms
    Fluency in foreign languages in addition to fluent English is a strong 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
    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

    Competencies

    Learning and applying quickly
    Organizing
    Priority Setting
    Problem Solving
    Interpersonal Savvy

    Apply via :

    cigna.wd5.myworkdayjobs.com

  • Provider Claims Intake Operations Supervisor

    Provider Claims Intake Operations Supervisor

    The Position:  

    We are looking for an enthusiastic, highly motivated and driven individual to join our Operations Team in the role of Provider Claims Intake Operations Supervisor.
    You will be responsible for the supervision of staff on a daily basis ensuring KPI’s are met across the Provider Claims Intake area.   

    Main Duties/Responsibilities:

    Provide visible leadership as part of the management team for the Provider Claims Intake team staff
    People development and performance management through active coaching, clear and constructive feedback and an open management style.
    Manage team resources through planning and leveraging the available talent to optimise team performance
    Engage staff in order to create a dynamic working environment at all levels, leading the team and the processes towards continuous progression while supporting the change journey
    Proactively optimizing the unit’s workflows to achieve set targets.
    Organising and monitoring work flow to ensure TAT targets are achieved and inventory levels are managed.
    Effectively manage the administration process liaising with the SME & Operations Manager about any identified gaps or improvements and proactively contributing to the solution.
    Ensure Quality Audit targets are achieved month on month
    Instrumental in Employee Engagement activity

    Your Profile

    Proven data analytics skills (advanced Excel, Qlikview, Tableau …) 
    Experience with systems like KOFAX, Octopus, Salesforce is a plus
    Excellent networking skills 
    Active language knowledge of at least English (additional languages are a plus)
    Experience in coaching, managing, developing and motivating individuals
    Clear experience in driving a team to achieve excellent customer service results
    Excellent inter-personal skills
    Negotiation and influencing skills
    Action-orientated problem-solving skills / process improvement
    Excellent organisation, planning and prioritisation skills
    Strong communication skills: demonstrating drive and enthusiasm
    Demonstrating flexibility and adaptability to change
    Result-oriented, able to mobilise the team to achieve key objectives
    Accountability – assumes ownership for achieving personal results and collective goals
    Customer oriented

    Key Competencies

    Leadership
    Transformation
    Manage ambiguity
    Balances stakeholders
    Organizational Savvy
    Drives Engagement
    Build effective teams
    Tech savvy
    Global perspective
    Data driven

    Apply via :

    jobs.thecignagroup.com

  • Provider Relations Supervisor

    Provider Relations Supervisor

    Job summary:

    As a Supervisor you will support the Senior Supervisor in managing Provider Relations team who operates with the providers of the Africa region.
    Your team will be based in Africa and delivers core services to our internationally contracted providers along the whole journey: from onboarding phase to education on Cigna’s tools and processes, management of complex operational issues.
    You will have the opportunity to collaborate with your peers and stakeholders around the globe.

    Your role includes:

    Team performance management: motivating individuals and teams collectively to achieve the agreed work output targets covering productivity, quality and provider satisfaction and take any corollary action of performance management where needed.
    Being responsible for the monitoring and follow up of the Provider Services KPIs across the region (suspensions and threat of suspensions, signoffs, aging of debt) and control and monitorization of operational KPIs of the network in the region (claims TAT and quality, complaints)
    Lead the team in a fast pace changing environment: ensure strong employee engagement within the team, including day to day oversight, motivation, conflict management, training, wellbeing and performance by providing coaching and skill development.
    Promote a culture of continuous improvement where you drive the improvements, follow up on them until they are implemented, and you measure their effectiveness afterwards.
    Proactive escalation of risks to your Manager in the field of Provider escalations, SLA achievement, people management.
    Proactive reach out to stakeholders in case of escalations, cross-collaboration or coordination of projects to guarantee the best provider experience.

    Your profile would be:

    Minimum of 2 years experience as a people manager of an operational team.
    A previous experience with a CRM tool such as Salesforce, or any planning tool.
    Desirable experience with management of remote/virtual teams
    You make data-driven assessments and decisions; you understand different operational and service metrics within Cigna and use them on a daily basis to articulate proposals & decisions that take into account a global scope.
    You’re tech-savvy, proficient at Excel and Microsoft Office
    You have a growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives and promote them across the organization
    You have availability to travel 5% of your time.

    Apply via :

    cigna.wd5.myworkdayjobs.com