Eligibility Representative – French Speaking

Cigna Healthcare Africa, founded in 1982, is a healthcare and insurance provider based in Nairobi, Kenya. The company focuses on delivering healthcare benefits and services, impacting members' healthcare journeys daily.

As an Eligibility Representative, you will play a critical role in facilitating members' access to essential healthcare benefits and services. This position serves as a primary point of contact for clients, customers, and internal teams, handling eligibility administration and maintaining precise member records. The role combines customer service, relationship management, data administration, and problem-solving within a dynamic international setting. You will collaborate with various functions to ensure a seamless member experience, focusing on data accuracy and operational excellence.

1. Accurately administer and maintain member eligibility information across various systems.
2. Process new enrollments, membership updates, terminations, and benefit changes in accordance with service-level agreements.
3. Update and maintain eligibility data using automated, direct-connect, and manual methods.
4. Serve as the main point of contact for eligibility inquiries from clients, customers, vendors, and internal stakeholders.
5. Investigate and resolve discrepancies, data errors, and system issues affecting member records.
6. Generate, analyze, and validate reports to ensure data integrity and operational accuracy.
7. Provide technical support and guidance related to eligibility administration processes.
8. Collaborate with clients and internal teams to resolve complex eligibility issues while fostering strong professional relationships.
9. Ensure customer and membership data is processed accurately, confidentially, and within specified timelines.
10. Identify opportunities for process improvement to enhance efficiency, service quality, and customer satisfaction.
11. Support business initiatives, projects, and continuous improvement activities within the Eligibility team.
12. Maintain compliance with data privacy, confidentiality, and regulatory requirements at all times.

1. Possess a Diploma, Bachelor’s degree, or equivalent professional experience.
2. Demonstrate excellent written and verbal communication skills in both English and French.
3. Exhibit a strong customer service orientation with a commitment to delivering exceptional customer experiences.
4. Show a high level of accuracy and meticulous attention to detail.
5. Be capable of managing multiple priorities and meeting deadlines in a fast-paced environment.
6. Possess strong problem-solving and analytical skills.
7. Be proficient in Microsoft Office applications, especially Excel and Outlook.
8. Have the ability to quickly learn new systems, technologies, and processes.
9. Experience in customer service, healthcare administration, insurance operations, or eligibility management is preferred.
10. Experience with customer databases, reporting tools, and case management systems is preferred.
11. Strong technical aptitude and ability to troubleshoot data and system-related issues are preferred.
12. Ability to build and maintain positive relationships with internal and external stakeholders is preferred.
13. Excellent organizational and time-management skills are preferred.
14. A commitment to continuous improvement and operational excellence is preferred.