Claims Associate Representative

The job profile for this position is Claims Associate Representative, which is a Band 1 Professional Career Track Role.

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Cigna – Claims Processor
The Position:
We are looking for a detail-oriented claims processor to join our insurance team. The role of a claims processor is to enter and adjudicate medical claims on a daily basis ensuring data integrity in the system. You will be responsible for processing member and provider claims of all regions withing the standard turn-around time, verifying information, and corresponding with hospitals 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 should adjudicate the claims in line with the policy coverage and medical necessity and validates the information on all medical claims from member and providers seeking payment. • Claims must be thoroughly reviewed to ensure that there is no missing or incomplete medical information. • Able to accurately assess medical eligibility within the guidelines and give evidence-based advice on claims, considering internationally accepted protocols and local and/or regional customs and regulations. • Should have the ability to review, investigate and respond to external and internal inquiries/complaints and provide guidance to others related to medical necessity. • 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. • Achieving required targets assigned on daily, weekly and monthly basis.
• Performing other clerical tasks, as required.
Claims Processor Requirements:
• Medical, paramedical Qualification Background with healthcare experience.
• At least 2 years of experience as a medical claim’s processor or in a related role.
• Knowledge of Medical Terminologies, CPT codes and ICD-+ 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

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

India
Uttar Pradesh
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