Senior Officer, Claims Management Specialist

6 days ago


Hong Kong, Central and Western District, Hong Kong SAR China The Cigna Group Full time

Job Summary

The Senior Officer, Claims Management will be responsible for handling pre-approval of commercial assessments, claims processes, and communicating with customers on pre-approval decisions. This role requires strong analytical and problem-solving skills to improve the effectiveness of claim adjudication and administration processes.

Key Responsibilities

  • Handle pre-approval of commercial assessments and claims processes, including inpatient and outpatient medical claims.
  • Communicate with customers on pre-approval decisions and provide timely updates.
  • Improve the effectiveness of claim adjudication and administration processes, working closely with network service providers as needed.
  • Handle provider claim enquiries from panel networks and respond to customer inquiries in a timely and professional manner.
  • Prepare reports to management on claims performance and provide recommendations for process improvements.
  • Conduct claim assessment processes, claim investigations, and review all status to ensure efficient outcomes in a customer-centric approach.
  • Meet individual quality, turnaround time, and productivity benchmarks.
  • Assist with project tasks and arrangements as needed.

Requirements

  • Diploma or above, preferably with insurance-related qualifications, such as FLMI or ICA.
  • At least 3 years' experience in claims adjudication/administration.
  • Experience in working with pre-approval of medical claims.
  • Strong analytical and problem-solving skills, with the ability to work independently and under pressure in a fast-paced environment.
  • Excellent communication and interpersonal skills, with the ability to work effectively with customers and internal stakeholders.
  • Cantonese speaker with good command of both English and Chinese.
  • Candidates without claims experience but with a medical-related degree will also be considered.

About The Cigna Group

The Cigna Group is a leading health insurance company that advocates for better health through every stage of life. We guide our customers through the healthcare system, empowering them with the information and insight they need to make informed decisions about their health and well-being. As a member of our team, you will have the opportunity to make a meaningful impact on people's lives and contribute to our mission of improving health and vitality.


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