GIH Claims Representative
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Job Location:
Monthly Salary:
Posted on:
5 days ago
Vacancies:
1 Vacancy
Job Summary
Key Responsibilities
- Assess and adjudicate GIH medical claims in line with policy terms medical guidelines and internal procedures within agreed turnaround times (TAT).
- Apply sound medical and policy knowledge to determine eligibility benefits and reimbursement amounts.
- Ensure accurate and complete data entry across claims systems maintaining audit-ready records.
- Identify potential fraud waste abuse or billing irregularities and escalate in line with internal protocols.
- Actively manage personal claim inventory to balance quality productivity and service levels.
- Collaborate with Team Leaders Medical Advisors and other internal stakeholders to resolve complex or unclear claims.
- Provide clear professional internal communication regarding claim decisions and outstanding requirements.
- Contribute to continuous improvement initiatives by highlighting process gaps quality issues and efficiency opportunities.
- Maintain strict confidentiality and comply with data privacy regulatory and compliance requirements at all times.
About The Cigna Group
Cigna Healthcare a division of The Cigna Group is an advocate for better health through every stage of life. We guide our customers through the health care system empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Required Experience:
Unclear Seniority
About Company
Cigna Healthcare offers health insurance plans such as medical and dental to individuals and employers, international health insurance, and Medicare coverage.
