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Claims Representative IOH

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The Cigna Group

2mo ago

  • Job
    Full-time
    Entry, Junior & Mid Level
  • People, HR & Administration
    Healthcare
  • Madrid

AI generated summary

  • You must have a relevant degree or experience, strong English, decision-making skills, numerical accuracy, discipline, efficiency, teamwork ability, computer proficiency, and discretion with confidential info.
  • You will process and evaluate claims, determine outcomes, interact with claimants and agents, and ensure compliance with policies while following established procedures.

Requirements

  • Degree or similar by experience (Foreign languages studies, translation and interpreting, administration, accountancy).
  • Active knowledge of English.
  • Good knowledge of any of these languages is a plus: German, Dutch, Greek, French, Italian, Portuguese, or any other European language.
  • Skillful in taking decisions: takes the right action on allocated files based on the available information.
  • Skillful with numbers: likes to work with numbers.
  • Accurate: works accurately on the input of data, aims to work faultlessly.
  • Discipline: pays attention to procedures, agreements and document flows.
  • Efficient: finds a good balance between quality and quantity.
  • Team player: Able to work in a team.
  • Skillful with computer programs: readily learns the ropes in the use of current office applications.
  • Discreet: works discreetly with confidential (medical) information.

Responsibilities

  • Delivers straightforward administrative and/or other basic business services in Claims.
  • Examines and processes paper claims and/or electronic claims.
  • Determines whether to return, pend, deny or pay claims within policies.
  • Determines steps necessary for adjudication.
  • Settles claims with claimants in accordance with policy provisions.
  • Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim.
  • Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.
  • Issues tend to be routine in nature.
  • Good knowledge and understanding of Claims and business/operating processes and procedures.
  • Works to clearly defined procedures under close supervision.

FAQs

What is the primary responsibility of a Claims Representative IOH?

The primary responsibility is to critically analyze and process medical claims within the fixed turnaround time while ensuring medical confidentiality.

What type of claims will the representative be processing?

The representative will be processing both paper and electronic claims for medical expenses.

What skills are required for this position?

Required skills include decision-making, numerical proficiency, accuracy, discipline, efficiency, teamwork, computer program proficiency, and discretion in handling confidential medical information.

Is there a specific educational requirement for the position?

Yes, a degree or similar experience in fields such as foreign languages, translation and interpreting, administration, or accountancy is required.

Which languages are beneficial to know for this role?

An active knowledge of English is required, and proficiency in German, Dutch, Greek, French, Italian, Portuguese, or any other European language is a plus.

How does the workload management work for this position?

Representatives are expected to follow up on their own workload, keeping track of volume and timing, and to inform the Supervisor about any claims lacking clarity.

What benefits are offered with this position?

Benefits include a long-term contract, a multicultural working environment with hybrid working options, flexible starting hours, and social benefits such as private medical and dental insurance, life assurance, and educational development programs.

What is the hybrid working model for this role?

Employees can work from home three days a week and spend two days in the Madrid office, with a shuttle bus provided from Madrid to the office.

What are the working hours for Claims Representatives?

Shifts start from 7:00 to 9:30 AM, providing the flexibility to choose the start time that suits you best, from Monday to Friday.

Is Cigna Healthcare an equal opportunity employer?

Yes, Cigna Healthcare considers qualified applicants without regard to various characteristics protected by applicable equal employment opportunity laws.

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The Cigna Group

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

The Cigna Group is a global health company committed to creating a better future built on the vitality of every individual and every community. We relentlessly challenge ourselves to partner and innovate solutions for better health. The Cigna Group includes products and services marketed under Cigna Healthcare, Evernorth Health Services or its subsidiaries. The Cigna Group maintains sales capabilities in more than 30 countries and jurisdictions, and has more than 190 million customer relationships around the world.