Medical Claims Representative at

1 month ago

Nairobi, Nairobi Area, Kenya Cigna Full time

Cigna is a global health service company, dedicated to helping the people we serve improve their health, well-being and sense of security.

Cigna has almost 40,000 employees who service over 80 million customer relationships around the world.

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.

Claims Processor Requirements:
Medical Qualification Background will be an added advantage.
At least 2 years of experience as a claim's processor 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

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