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
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