Cigna Careers

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.

Relations To Other Positions

• Assist the Supervisor and Senior Supervisor in several tasks (e.g. preparation of presentations, preparation of analyses, Statistics)
• Provide all necessary information to the involved parties: clients, insurers, the International Customer Services, Finance and Accounting Marketing and Communication.
• Contribute to maintaining a co-operative and friendly working environment.
• Inform Supervisors and Senior Supervisors on problems and inefficiencies.

What do you need?

• Must have a diploma or bachelor’s degree or equivalent
• Minimum one year or more experience in any related field (Customer Service – Handling calls and responding to client on free text email basis)
• Primary language will be English but will be good to have additional language i.e. Portuguese or French or German
• 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.

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

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

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

YOUR JOB

As a Supervisor you will support the Senior Supervisor in managing a team of Provider Claims Representatives. Key to the role will be developing and coaching the team to deliver a high-quality customer centric service offering.

Your role includes:

• Accountable to review and assess inventory levels coordinating daily allocations and planning ahead to maximize staffing levels to maximize results.
• Accountable to ensure that productivity, quality and customer satisfaction, are managed within own team and motivation of the individuals and team to achieve the operational KPI’s; Attend KPI calls can help you to achieve this.
• Recommending and implementing innovative strategies to improve efficiency and provide excellent customer service.
• Being proactive in identifying improvement/enhancement opportunities and be active in seeking and sharing ideas for innovation in business processes.
• Being responsible for follow-up of capacity planning and absences in close cooperation with HR.
• 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 in collaboration with the Claims Management Team.
• Ensure appropriate performance management actions are taken.
• Having quarterly check-in conversations with all team members
• Promote a culture of continuous improvement and be fully responsible for the implementation of new Operating Model and the measurement of the results in alignment with the broader PSO Strategy and in coordination with the Management Team.
• Taking ownership of any escalated claims and provide updates to the Senior Supervisor on any issues.
• Proactively address and/or escalate any operational risks.
• Developing/maintaining proactive/effective business relationships, both internally and externally to ensure a seamless delivery of service. Actively encourage all team members to do likewise (e.g. Cigna links).
• Handle financial verification as per agreed process.

YOUR PROFILE

• Strong performance track record.
• International mind-set, and able to work remotely with peers across locations.
• Relevant leadership experience in other functions/companies.
• Knowledge in relation to Provider claims will be a plus.
• Experience in and passion for coaching, managing, developing and motivating individuals and the team.
• Experience in complaint management - with a proven track record in improving customer service standards.
• Strong presentation skills, and knowledge of Window Office tools like Word, Outlook, Excel, PowerPoint.
• A growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives.
• Excellent interpersonal skills: strong empathy and listening skills, strong articulation and communications skills.
• Striving for excellent service to our members, clients and providers is part of your DNA.
• Competency to build a team and create an atmosphere of positive collaboration, innovation and creative solutions among the team members.
• Action-orientated problem-solving attitude.
• Excellent organization, planning and prioritization skills.
• Able to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues.
• Results orientated – ability to cascade and explain goals, establish plans and manage work to achieve desired outcomes.
• Create meaningful business-related metrics and track progress/results.
• Accountability – assume ownership for achieving personal results and collective team goals.

What would a typical day look like for a Customer Service Representative?

As an Eligibility Representative, you are part of a team of young and international colleagues and every day you come across a wide variety of situations:

Your Responsibilities:

• Delivers administrative duties and other Business services in Eligibility.
• Implements and maintains eligibility for benefits.
• Implements, updates and maintains automated, direct connect and manual Eligibility data.
• Interacts with internal & external clients and vendors to resolve issue.
• Generates reports from the system, identifies and resolves discrepancies.
• Identifies and recommends process improvement opportunities in the Department.
• Negotiates and resolves Eligibility with clients.
• Provides technical support for electronic process of eligibility.
• Ensures customer data is installed accurately and in a timely manner.
• Works with clients’ data format and internal Systems to resolve errors and technical issues.

What skills do you need?

• Do you have a degree / Diploma or similar level by experience and an excellent knowledge of English and French?
• Great start! That’s essential for the role. If you possess excellent attention to detail, even better! You are an expert in delivering an excellent customer experience and you're quick to learn new software applications? Great!
• If on top of that you have good technical and reporting skills, you are a fast learner, strong interpersonal skills with excellent written/verbal communication skills and you are a positive thinker who is used to working meticulously against tight deadlines, then you might be the ideal CSR!

You will love this job if you

• Actively want to use your language knowledge.
• Love customer centric interactions over the phone.
• Find great satisfaction in problem-solving and being proactive.
• Like to take responsibility and make proposals to improve procedures.
• Handle files in a structured and organized way.
• See the importance of handling confidential information discretely.
• Like to actively interact with colleagues of different departments and with a global team.

Cigna can offer you

• A challenging job in an international and diverse context
• ‘Happy You’: health and wellbeing initiatives, flexible hours, home working opportunities
• A dynamic international team, team leaders who train you patiently and a team manager who makes time for you
• An attractive salary and extra-legal benefits

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

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.

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