Senior Officer, Claims Management
4 weeks ago
We are seeking a highly skilled and experienced Senior Officer, Claims Management to join our team at The Cigna Group. As a key member of our claims management team, you will be responsible for handling pre-approval of commercial assessments, claims processes, and communicating with customers on pre-approval decisions.
Key Responsibilities- Manage the pre-approval process for commercial assessments, ensuring timely and accurate decisions.
- Handle claims processes, including inpatient and outpatient medical claims, and ensure efficient outcomes.
- Communicate effectively with customers on pre-approval decisions, providing clear and concise information.
- Collaborate with network service providers to improve the effectiveness of claim adjudication and administration processes.
- Handle provider claim enquiries from panel networks, ensuring prompt and professional responses.
- Prepare reports for management, highlighting key performance indicators and areas for improvement.
- Conduct claim assessment processes, investigations, and reviews to ensure efficient outcomes and customer satisfaction.
- Meet individual quality, turnaround time, and productivity benchmarks, ensuring high standards of performance.
- Assist with project tasks and arrangements, contributing to the smooth operation of the claims management team.
- Degree in a relevant field, preferably with insurance-related qualifications, such as FLMI or ICA.
- At least 3 years' experience in claims adjudication or administration, with a strong understanding of medical claims processes.
- Excellent communication and interpersonal skills, with the ability to work effectively in a fast-paced environment.
- Strong analytical and problem-solving skills, with the ability to interpret complex data and make informed decisions.
- Cantonese speaker with good command of both English and Chinese, with the ability to communicate effectively with customers and colleagues.
- Ability to work independently and as part of a team, with a customer-centric mindset and a commitment to delivering high-quality results.
The Cigna Group is a leading health insurance provider, dedicated to empowering our customers to make informed decisions about their health and wellbeing. We are committed to delivering high-quality services and products that meet the evolving needs of our customers.
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