Urgent! Claims Representative Job Opening In Kuala Lumpur – Now Hiring The Cigna Group
**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**
+ 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
**KNOWLEDGE, SKILLS AND EXPERIENCE**
+ At least 1-2 years of experience performing a similar role.
+ 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 for overtime.
**COMMUNICATIONS AND WORKING RELATIONSHIPS**
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.
✨ Smart • Intelligent • Private • Secure
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Unlock Your Claims Representative Potential: Insight & Career Growth Guide
Real-time Claims Representative Jobs Trends in Kuala Lumpur, Malaysia (Graphical Representation)
Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for Claims Representative in Kuala Lumpur, Malaysia using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 3185 jobs in Malaysia and 618 jobs in Kuala Lumpur. This comprehensive analysis highlights market share and opportunities for professionals in Claims Representative roles. These dynamic trends provide a better understanding of the job market landscape in these regions.
Great news! The Cigna Group is currently hiring and seeking a Claims Representative to join their team. Feel free to download the job details.
Wait no longer! Are you also interested in exploring similar jobs? Search now: Claims Representative Jobs Kuala Lumpur.
An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at The Cigna Group adheres to the cultural norms as outlined by Expertini.
The fundamental ethical values are:The average salary range for a Claims Representative Jobs Malaysia varies, but the pay scale is rated "Standard" in Kuala Lumpur. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.
Key qualifications for Claims Representative typically include Other General and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.
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Here are some tips to help you prepare for and ace your job interview:
Before the Interview:To prepare for your Claims Representative interview at The Cigna Group, research the company, understand the job requirements, and practice common interview questions.
Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the The Cigna Group's products or services and be prepared to discuss how you can contribute to their success.
By following these tips, you can increase your chances of making a positive impression and landing the job!
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