MAJOR RESPONSIBILITIES
Part of a clinical team that provides medical management services to customers worldwide but mainly in Africa region.
Give evidence-based advice on pre-authorization, considering internationally accepted protocols and local and/or regional customs and regulations.
Assessing pre-authorization requests claims in line with the policy coverage and medical necessity.
Identify and refer cases to the Cigna Clinical team for case management, disease management and other clinical services
Assist and support the team in cost containment, assist in projects and service delivery to meet goals.
To assist queries from providers and payers via phone calls or e-mails
Be fully versed with medical insurance policies for various groups / beneficiaries.
Might be required to assist in training colleagues and sharing knowledge.
Ability to review, investigate, and respond to external and internal inquires/complaints and provide guidance to other clinical and non-clinical staff related to medical necessity.
Assist in fraud detection
Meeting the defined qualitative and quantitative key performance metrics for the assigned job role.
Ensure adherence to the predefined TATs for pre-approvals
Achieving required targets assigned by the team leader on daily, weekly, and monthly basis.
Ensure compliance to any changes in terms of system parameters or process.
Other duties as assigned
REQUIREMENTS
University degree of Medical /Nursing specialization with international healthcare experience.
2-3 years of clinical experience preferable in a payer setting on medical management.
Experience in the Africa region & International market
Fluent in English along with either French, Portuguese or Spanish, any other language is a plus
Strong interpersonal and communication skills.
Must be a computer literate
Knowledge of utilization, cost containment services, insurance coverage.
Ability to build solid working relationships with staff, clients, customers, and healthcare providers.
Demonstrates pro-active problem-solving and analytical skills
Ability to work under pressure and meet tight deadlines
Flexible to work on shifts/varying work schedules.
OUR OFFER
A challenging job in an international and growing enterprise.
A dynamic, young and entrepreneurial company culture that values and stimulates initiative.
Attractive salary conditions with extralegal benefits.
Apply via :
cigna.wd5.myworkdayjobs.com
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