Clinical Claims Review Senior Analysts

2 days ago

Nairobi, Nairobi Area, Kenya The Cigna Group Full time 120,000 - 240,000 per year

  Role summary

The clinical value team is looking for 2 Medical Claims Review Senior Analysts (Band 3)

As part of the Claims Review team you will be primarily responsible for the Medical Review, Coding, MNR and ICR of claims.

You will be:

  • Interpreting key information from medical reports/invoices and translating this into medical coding in our hospitalizationdatabase and/or Salesforce application 'Healthcloud'
  • Analyzing invoices from providers all over the world to identify cost containment opportunities and you will be taking appropriate actions in line with our procedures to avoid unnecessary costs for our clients, members and Cigna
  • Reviewing claims from a clinical point of view directly with Providers
  • Collaborating with colleagues in different teams and roles (Claims Analysts, CSR's, Doctors, Nurses etc) across the business while bridging cultural differences & backgrounds
  • Attending weekly/Monthly/ad-hoc meetings with the team & supervisor to discuss and improve internal workflows and collaboration
  • Serving as a contact person for other teams within Clinical and the wider business for expert advice on R&C calculations
  • Taking ownership of your production making sure you meet the expected outputs

YOUR PROFILE

  • Proficient in English
  • Clinical Background (Nurse/Clinical officer)
  • Passive knowledge of French/German/Italian. Additional languages is a plus
  • Experience with processing provider claims is a plus
  • Affinity with medical terminology is a plus
  • ICD knowledge is a plus
  • Communicative and not afraid to approach people
  • Proactive and driven
  • You can deal with integrity
  • Tech savy, not afraid to work in/with different systems/applications at the same time
  • Eye for detail and love for accurateness
  • Flexible with the ability to shift priorities when required
  • Not afraid of moving forward in the midst of ambiguity

About Cigna Healthcare

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.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

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