Claims Representative

Cigna Healthcare is a global health service company founded in 1982, specializing in healthcare and insurance solutions. They aim to improve the health, well-being, and peace of mind of those they serve.

The Claims Representative will be responsible for processing international medical, dental, and vision claims according to policy terms and conditions, striving to meet personal and team productivity and quality goals. This role requires monitoring high-cost claims and ensuring relevant parties are informed. The representative must also ensure claims are settled within required timeframes, escalating to their supervisor if this is not achievable. They will respond promptly to inquiries regarding plan design, eligibility, and claim status, aiming for first-call resolution. Effective interaction with both internal and external customers is crucial for resolving issues. Additionally, the role involves identifying potential process improvements and making recommendations to senior team members, actively supporting other team members to achieve overall goals, and working across European business operations as service needs dictate. Other ad-hoc tasks may be required to meet business needs.

1. Adjudicate international medical, dental, and vision claims in line with policy terms and conditions, meeting productivity and quality targets.
2. Monitor and flag high-cost claims, ensuring relevant parties are informed.
3. Ensure claims are settled within required timeframes, escalating to supervisors if targets cannot be met.
4. Respond to inquiries about plan design, eligibility, and claim status promptly, aiming for first-call resolution.
5. Interact effectively with internal and external customers to resolve issues.
6. Identify and recommend potential process improvements to senior team members.
7. Support other team members to help achieve all team goals.
8. Work across European business operations as service needs dictate.
9. Perform other ad-hoc tasks as required by business needs.

1. At least 1 year of experience in a claims role within healthcare, insurance, or a related environment.
2. Customer-focused with proven ability to identify and solve problems.
3. Capable of meeting or exceeding targets and managing multiple priorities effectively.
4. Proficient in Microsoft Office applications.
5. Demonstrated proficiency in mathematics, with strong attention to detail and accuracy in numerical handling.
6. Excellent attention to detail and high level of accuracy.
7. Strong interpersonal skills with good verbal and written communication for internal and external clients.
8. Ability to work independently and proactively recommend and implement process improvements.
9. Strong organizational skills to prioritize and manage workflow to meet individual and team requirements.
10. Ability to exercise sound judgment.