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Vacancy
1 Vacancy
Job Description
Roles & Responsibilities
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.
Requirement :
- Medical Qualification Background will be an added advantage.
- At least 5 years of experience as a claim 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
Desired Candidate Profile
You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries and also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.
To be successful, you should have excellent organizational and interpersonal skills and also be able to work under pressure and perform a range of clerical functions with great attention to detail.
Context : Must have a Technical expertise with depth or breadth of knowledge within Claims, Responsible for researching and resolving escalated and complex claim issues in a timely manner. Identifies error trends and notifies the appropriate areas for correction, communicating/educating the necessary parties. Provides recommendations regarding process improvements. Communicates with service providers, attorneys, policyholders, and other involved parties. Provides guidance, coaching, and direction to more junior team members of the team. Acts independently working under limited supervision.
Company Industry
- Fitness
- Wellness
- Gym
- Salon
- Spa
Department / Functional Area
- Insurance
- Underwriting
- Surveying
- Actuary
Keywords
- Claims Lead Analyst
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Cigna
At The Cigna Group, we re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.p