Claims Representative (GEH) – Provider Service Organisation

Cigna Healthcare Africa is a healthcare and insurance company founded in 1982, with operations based in Nairobi, Kenya. They specialize in providing healthcare and pharmaceutical services, alongside insurance solutions.

This role involves performing fundamental technical, administrative, and operational tasks related to claims processing. The representative will be responsible for reviewing and handling both paper and electronic claims submitted by healthcare providers, including data entry, file maintenance, and general support. The position requires adherence to straightforward instructions and procedures, with duties performed under close supervision. Tasks are assigned daily or on a per-task basis with clear guidelines, serving as an entry point into professional career paths.

1. Process international medical, dental, and vision claims, ensuring compliance with policy terms and conditions to achieve individual and team productivity and quality targets.
2. Identify and flag high-cost claims, ensuring relevant stakeholders are informed.
3. Track claim processing times to ensure settlements occur within specified deadlines, escalating to a supervisor if delays are anticipated.
4. Address inquiries regarding plan design, eligibility, and claim status within set timeframes, aiming for first-call resolution.
5. Collaborate effectively with both internal and external clients to resolve provider-related concerns.
6. Manage all aspects of claims for an assigned Provider Country Cluster.
7. Propose and recommend potential enhancements to existing processes to senior team members.
8. Provide active support and resources to colleagues to help achieve overall team objectives.
9. Contribute to European business operations as service needs dictate.
10. Perform additional duties as assigned to meet business requirements.

1. A Bachelor's Degree is required.
2. A minimum of 3 years of relevant experience is necessary.
3. Demonstrated customer-centric approach with strong problem-solving capabilities.
4. Proven ability to achieve or surpass targets and effectively manage multiple tasks simultaneously.
5. Proficiency in Microsoft Office applications.
6. Excellent attention to detail and a high degree of accuracy.
7. Strong interpersonal skills, including effective verbal and written communication for interacting with internal and external clients.
8. Capacity to work independently and proactively suggest and implement process improvements.
9. Skilled in organizing, prioritizing, and managing workload to meet both individual and team objectives.
10. Sound judgment abilities.
11. Prior experience in medical administration, a claims environment, or a contact center is beneficial but not mandatory.
12. English and Arithmetic qualifications are preferred.