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Intake Care Associate Analyst

Cigna Healthcare · Nairobi

New
🇬🇧 English
Medical claims adjudication Prior authorization Utilization management

Job description

About the role

Cigna Healthcare is hiring an Intake Care Associate Analyst, a preauthorization, claims review, negotiation and care coordination analyst. The role manages the full continuum of care management and cost containment, from pre-service authorization through post-service claims review and provider negotiations, ensuring clinical appropriateness, policy compliance and cost-effective care for complex and high-risk members.

Key responsibilities

  • Review and process preauthorization requests for medical services, procedures and treatments, assessing medical necessity against clinical guidelines, policy criteria and regulatory requirements
  • Collaborate with clinical teams to ensure the appropriate level of care and service utilization
  • Identify high-risk or high-cost cases early and route them to care coordination or case management
  • Review medical claims for accuracy, coding integrity and benefit alignment, and flag billing discrepancies, overutilization and cost-saving opportunities
  • Support appeals, reconsiderations and audits, analyze trends in high-cost claims and recommend process improvements
  • Negotiate out-of-network claims, high-cost procedures and single case assignments, and document savings outcomes
  • Partner with case management, clinical teams and providers to ensure continuity and quality of care

Required profile

  • Degree or diploma; additional education in healthcare, business or related fields preferred
  • Knowledge of medical claims adjudication, prior authorization, medical necessity review and utilization management guidelines, with the ability to review clinical documentation and apply coverage criteria
  • Excellent written and oral communication skills, flexibility and ability to multi-task
  • High accuracy, attention to detail, problem-solving and team spirit
  • Ability to interpret data and identify trends
  • Shift work: 8:00 PM - 6:00 AM EAT (Sat-Wed), 9:00 PM - 7:00 AM EAT (Wed-Sun) or 7:00 AM - 3:00 PM EAT (Sat-Wed); weekends and holidays required

Questions fréquentes

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Published 16 hours ago

Expires 1 month from now

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Cigna Healthcare

Nairobi