Provider Claims Representative

Job Description SummaryDelivers straightforward administrative and/or other basic business services in Claims. 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. 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. Issues tend to be routine in nature. Good knowledge and understanding of Claims and business/operating processes and procedures. Works to clearly defined procedures under close supervision.ABOUT US:Cigna Corporation is a global health service company. We provide healthcare products and services, group disability, life and accident insurance and international insurance – directly to individuals and through employers and intermediaries.Cigna's mission is to help our customers improve their health, well-being and sense of security.YOUR MISSION:Critical analysis and processing of claims for medical expenses within the fixed turn around time.KEY AREAS:Claims processing:Assessing and processing claims for medical expenses while always bearing in mind the importance of Claims processing:Assessing and processing claims for medical expenses while always bearing in mind the importance ofmedical confidentiality.Accurate data input to the PC and mainframe applications.Positioning himself/herself analytically and critically in the context of cost management and in respect ofexisting working methods.Following up his/her own workload (volume and timing): keeping an eye on chronology and processingtime of the work volume and taking suitable actions.Participate efficiently in processing the flow of claims: inform the Supervisor about claims lacking clarity and about possible ways of optimising the processes.A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactionsare important motivators. In relation to other positions:Providing accurate communication about a dossier to the interested internal employee.Tracking irregularities in procedures and highlighting these to the Supervisor.Raising problems or sensitivities with your superior.Participating actively in an agreeable and amicable atmosphere.SKILLS AND KNOWLEDGE:Degree or similar by experience (Foreign languages studies, translation and interpreting, administration, accountancy).Specific Knowledge:Active knowledge of English.Good knowledge of any of these languages is a plus: German, Dutch, Greek, French, Italian, Portuguese, or any other European language.Skills:Skillful in taking decisions: takes the right action on allocated files based on the available information.Skillful with numbers: likes to work with numbers.Accurate: works accurately on the input of data, aims to work faultlessly.Discipline: pays attention to procedures, agreements and document flows.Efficient: finds a good balance between quality and quantity.Team player: Able to work in a team.Skillful with computer programs: readily learns the ropes in the use of current office applicationsDiscreet: works discreetly with confidential (medical) information.What we offer:Multicultural working environment with Hybrid workingEnjoy working from the comfort of your home 3 days per week and 2 days from our Madrid office (shuttle bus from Madrid to the office).Flexible starting hour– Our shifts start from 7:00 to 9:30, with possibility to choose the time that suits you best (Monday to Friday - Morning intensive shift ).Private Medical and Dental Insurance, Life Assurance, Educational Development Program, Foreign Language Scholarship, flexible compensation.It's time to look to your future and apply to work for Cigna todayAbout Cigna HealthcareCigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Job Description SummaryDelivers straightforward administrative and/or other basic business services in Claims. 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. 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. Issues tend to be routine in nature. Good knowledge and understanding of Claims and business/operating processes and procedures. Works to clearly defined procedures under close supervision.ABOUT US:Cigna Corporation is a global health service company. We provide healthcare products and services, group disability, life and accident insurance and international insurance – directly to individuals and through employers and intermediaries.Cigna's mission is to help our customers improve their health, well-being and sense of security.YOUR MISSION:Critical analysis and processing of claims for medical expenses within the fixed turn around time.KEY AREAS: Claims processing:Assessing and processing claims for medical expenses while always bearing in mind the importance ofmedical confidentiality.Accurate data input to the PC and mainframe applications.Positioning himself/herself analytically and critically in the context of cost management and in respect ofexisting working methods.Following up his/her own workload (volume and timing): keeping an eye on chronology and processingtime of the work volume and taking suitable actions.Participate efficiently in processing the flow of claims: inform the Supervisor about claims lacking clarity and about possible ways of optimising the processes.A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactionsare important motivators. In relation to other positions:Providing accurate communication about a dossier to the interested internal employee.Tracking irregularities in procedures and highlighting these to the Supervisor.Raising problems or sensitivities with your superior.Participating actively in an agreeable and amicable atmosphere. SKILLS AND KNOWLEDGE: Education Level:Degree or similar by experience (Foreign languages studies, translation and interpreting, administration, accountancy). Specific Knowledge:Active knowledge of English.Good knowledge of any of these languages is a plus: German, Dutch, Greek, French, Italian, Portuguese, or any other European language.Skills:Skillful in taking decisions: takes the right action on allocated files based on the available information.Skillful with numbers: likes to work with numbers.Accurate: works accurately on the input of data, aims to work faultlessly.Discipline: pays attention to procedures, agreements and document flows.Efficient: finds a good balance between quality and quantity.Team player: Able to work in a team.Skillful with computer programs: readily learns the ropes in the use of current office applicationsDiscreet: works discreetly with confidential (medical) information.What we offer:Long Term contractMulticultural working environment with Hybrid workingEnjoy working from the comfort of your home 3 days per week and 2 days from our Madrid office (shuttle bus from Madrid to the office).Flexible starting hour– Our shifts start from 7:00 to 9:30, with possibility to choose the time that suits you best (Monday to Friday - Morning intensive shift ).Social BenefitsPrivate Medical and Dental Insurance, Life Assurance, Educational Development Program, Foreign Language Scholarship, flexible compensation.It's time to look to your future and apply to work for Cigna todayAbout Cigna HealthcareCigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.If you require reasonable accommodation in completing the online application process, please email: ****** for support. Do not email ****** for an update on your application or to provide your resume as you will not receive a response.
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