.Job Description Summary Delivers specific delegated Claims tasks assigned by a supervisor. Examines and processes paper claims and/or electronic claims. Determines whether to return, pend, deny or pay claims within policies. Determines steps necessary for adjudication. Follows established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues. Settles claims with claimants in accordance with policy provisions. Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim. Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries. Completes day-to-day tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues.The Position: One vacancy has arisen within IOH Provider Claims in Madrid opening up the opportunity for enthusiastic, highly motivated, and driven individuals to join Our Operations Team in the role of IOH Claims Senior Representative.You will support the Supervisor and provide leadership to staff on a daily basis ensuring KPl's are met across the Claims Organization.Main Duties/Responsibilities: Provide Coaching/Development for Claims team staff.Review team performance and ensure coaching opportunities are identified.When required, ownership of BPO team scorecards updating performance and ensuring coaching opportunities are identified.Quality Audit execution and reporting results ensuring Quality Audit targets are achieved.Engage staff to create a dynamic working environment at all levels, supporting the team and the processes towards continuous improvement while supporting the change journey.Proactively optimizing the unit's workflows to achieve set targets.Managing the senior queues daily.Monitoring and managing workflow to ensure TAT targets are achieved and inventory levels are managed.Instrumental into the Claims Processes to ensure risks are highlighted.1st Point of contact for Escalations.Mainframe and financial transactions.Ad-hoc projects.As required, processing or verifying.Requirements: 1 year experience in processing Provider claims.Ability to complete tasks with little or no supervision.Self-motivated with a proactive approach.Exceptional attention to detail and accuracy.Ability to take ownership.Demonstrated Coaching/Development Experience.Work well in a team environment.Computer literacy (especially Excel).Ability to learn in a virtual environment.Excellent problem solving skills.Confidentiality Management of Data.Leadership Skills will be a plus.About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life
