Claims Representative

7 days ago

Nairobi, Nairobi Area, Kenya Cigna Healthcare Full time 900,000 - 1,200,000 per year

You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

To be successful as a claim's processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.

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 Diploma or Degree level is a requirement.

  • 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

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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