IOH Member Claims Representative

About the role

Cigna Healthcare is hiring an IOH Member Claims Representative. As Claims Representative you analyse claims for client medical costs and adjudicate medical, dental and vision claims in line with policy terms and conditions, aiming for personal and team productivity and quality goals.

Key responsibilities

• Analyse claims and reimbursements according to contract agreements, assessing, coding and calculating them with a computerised claims processing system.
• Pass communications to the communication team so issues with stakeholders can be solved or prevented.
• Monitor turnaround times and flag to your supervisor when claims cannot be settled within required time scales.
• Take ownership of complex cases and keep your knowledge of medical information up to date through training.
• Report inaccuracies in files to your team leader or departmental head.
• Respond to enquiries on plan design, eligibility and claims status, aiming for first-call resolution, and carry out ad hoc tasks as needed.

Required profile

• Diploma or degree in a relevant field.
• Previous experience handling medical claims in a health insurance or healthcare provider environment is an added advantage.
• Strong working knowledge of English; French is an added advantage.
• Desirable: previous analytical role with strong numerical ability, accuracy and attention to detail.
• Good analytical and problem-solving skills, customer-focused, able to work independently and adapt quickly to changing processes and systems.
• Integrity and discretion with confidential medical or customer information.

Required skills

• Comfortable learning and working with computer-based applications and claims processing systems.
• Claims analysis and adjudication.