- Processes claims from members and providers.
- Assists queries from providers and payers via phone calls or e-mails.
- Maintains files for authorizations and other reports.
- Assesses and processes claims in line with the policy coverage and medical necessity.
- Be fully versed with medical insurance policies for various groups / beneficiaries.
- May assist in training colleagues and asked to share knowledge.
- Accurately assesses eligibility within the policy boundaries.
- Monitors and maintains the claims processing as per the defined terms and policy of the organization.
- Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis.
- Monitors the qualitative and quantitative measures for claims & pre-approvals.
- Ensures compliance to any changes in terms of system parameters or process.
- Maintains quality as per framework for accuracy.
- Maintains productivity and responsiveness to the work allocated.
- Collaborate with other stakeholders / teams to resolve queries including complex queries.
- Actively support all team members to enable operational goals to be achieved.
- Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).
- Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality.
- Accurate data input to the system applications.
- Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods.
- Following up 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.
- Monitor and highlight high-cost claims and ensure relevant parties are aware.
- Follow Claim Manual and SOP strictly, adjudicate claims according to benefit policies, and meet both financial/procedure accuracy and TAT target on claims adjudication.
- Adjust error claims according to actual situation.
- Well handle recoupment and reconciliation work, communicate with providers and members via call and email for collection and explanation.
- Work with cross function teams, such as Finance, CSR, Eligibility, Network, Client Management, etc. Ensure recoupment work go smoothly.
- Actively support Team Leader and work with claim colleagues to enable all operational goals to be achieved
- At least 1-2 years of experience performing a similar role.
- Medically qualified as a doctor.
- Experience of working for an international company, preferred but not essential.
- Claims processing or insurance experience, preferred but not essential.
- Broad awareness of medical terminology, advantageous.
- Excellent organizational skills, capable of following and contributing to agreed procedure.
- Strong administration awareness and experience, essential.
- Strong skills in Microsoft Office applications, essential.
- First class written and verbal communication skills, essential.
- Ability to communicate across a diverse population, essential.
- Capable of working independently, or as part of a team.
- Good time management, ability to work to tight deadlines.
- Flexible and adaptable approach, sometimes working in a fast-paced environment.
- Passion for achieving agreed objectives.
- Confident in calling out when facing issues.
- Should be flexible to work in shifts and on staggered weekends
-
Claims Representative A
4 days ago
The Cigna Group Kuala Lumpur, MalaysiaPOSITION : Claims Representative · REPORTING TO : Claims Senior Representative / Supervisor · 1. JOB PURPOSE · The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and ...
-
Claims Representative
7 hours ago
The Cigna Group Kuala Lumpur, MalaysiaCigna is one of the world's leading providers of health care, expatriate employee benefits, life, accidental and supplemental health insurance. Headquartered in the US and listed in NYSE, the Company operates in countries across the Americas, Europe, Africa and Asia Pacific. · Ci ...
-
Claims Representative
3 days ago
The Cigna Group Kuala Lumpur, MalaysiaCigna is one of the world's leading providers of health care, expatriate employee benefits, life, accidental and supplemental health insurance. Headquartered in the US and listed in NYSE, the Company operates in countries across the Americas, Europe, Africa and Asia Pacific. · Ci ...
-
Claims Representative
1 week ago
The Cigna Group Kuala Lumpur, Malaysia**Scope** · Critical analysis and processing of claims for medical expenses within the fixed turn-around time. · **Job content** · **Claims processing** · - Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality ...
-
Claims Representative A
7 hours ago
The Cigna Group Kuala Lumpur, Malaysia**JOB PURPOSE** · The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She s ...
-
Claims Representative A
3 days ago
The Cigna Group Kuala Lumpur, MalaysiaClaims processing · - Processing claims under GEH APAC book of business · - Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. · - Positioning him/herself analytically and critically in the context of cost ...
-
Gih Claims Representative
1 week ago
The Cigna Group Kuala Lumpur, Malaysia**JOB PURPOSE** · The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She s ...
-
Claims Representative-2
6 days ago
The Cigna Group Kuala Lumpur, MalaysiaCritical analysis and processing of claims for medical expenses within the fixed turn around time. · **Job content** · - Claims processing_ · - Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. · - Positio ...
-
Claims Representative-3
1 week ago
The Cigna Group Kuala Lumpur, MalaysiaCigna is one of the world's leading providers of health care, expatriate employee benefits, life, accidental and supplemental health insurance. Headquartered in the US and listed in NYSE, the Company operates in countries across the Americas, Europe, Africa and Asia Pacific. · Ci ...
-
Claims Representative
1 week ago
The Cigna Group Kuala Lumpur, Malaysia Full timeThe job profile for this position is Claims Senior Representative A, which is a Band 2 Professional Career Track Role.Excited to grow your career? · We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting n ...
-
Claims Representative
1 week ago
The Cigna Group Kuala Lumpur, Malaysia OTHERThe job profile for this position is Claims Representative A, which is a Band 1 Professional Career Track Role.Excited to grow your career? · We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new tale ...
-
Claims Representative A
1 week ago
The Cigna Group Kuala Lumpur, Malaysia OTHERThe job profile for this position is Claims Representative A, which is a Band 1 Professional Career Track Role.Excited to grow your career? · We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new tale ...
-
Claims Representative
6 days ago
The Cigna Group Kuala Lumpur, Malaysia OTHERThe job profile for this position is Claims Representative A, which is a Band 1 Professional Career Track Role.Excited to grow your career? · We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new tale ...
-
Claims Representative A
4 days ago
The Cigna Group Malaysia, Kuala Lumpur Full timeClaims processing Processing claims under GEH APAC book of business · Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. · Accurate data input to the system applications. · Positioning him/herself analytica ...
-
Claims Representative
1 day ago
The Cigna Group Kuala Lumpur, Malaysia OTHERScope · Critical analysis and processing of claims for medical expenses within the fixed turn-around time. · Job content · Claims processing · - Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. · - Accura ...
-
Claims Representative
6 days ago
The Cigna Group Kuala Lumpur, Malaysia OTHERCigna is one of the world's leading providers of health care, expatriate employee benefits, life, accidental and supplemental health insurance. Headquartered in the US and listed in NYSE, the Company operates in countries across the Americas, Europe, Africa and Asia Pacific. · Ci ...
-
Claims Representative
2 weeks ago
The Cigna Group Kuala Lumpur, Malaysia OTHERScope · Critical analysis and processing of claims for medical expenses within the fixed turn-around time. · Job content · Claims processing · - Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. · - Accura ...
-
Claim representative
6 days ago
The Cigna Group Kuala Lumpur, Malaysia OTHERClaims processing · Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. · Accurate data input to the system applications. · Positioning him/herself analytically and critically in the context of cost manageme ...
-
Claims Representative-2
4 days ago
The Cigna Group Kuala Lumpur, Malaysia OTHERCritical analysis and processing of claims for medical expenses within the fixed turn around time. · Job content · Claims processing · Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality. · Accurate data inpu ...
-
Claims Representative-3
6 days ago
The Cigna Group Kuala Lumpur, Malaysia OTHERCigna is one of the world's leading providers of health care, expatriate employee benefits, life, accidental and supplemental health insurance. Headquartered in the US and listed in NYSE, the Company operates in countries across the Americas, Europe, Africa and Asia Pacific. · Ci ...
Claims Representative - Malaysia, Kuala Lumpur - The Cigna Group
Description
Job DescriptionPOSITION : Claim Representative
REPORTING TO: Claim Supervisor or Manager
DEPARTMENT : Claims
Career Band : Band 1
Job Purpose
The job holder is responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database. He/She is responsible for processing as per terms of benefits. He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.
Responsibilities And Duties
The job holder must ensure building strong effective relationships with all his matrix partners and demonstrating approachability and openness. He/ She must be able to foster strong internal and external communication standards.
About The Cigna Group
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.