Medical Claims Representative at Cigna
- Published date: April 12, 2024
- Category: Administrative & Office
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- Location: Nairobi, Nairobi
- Jop type:
- Salary: Ksh Not mentioned
- Company name: Jobs in Kenya
Job Description
Main Duties / Responsibilities
- A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
- Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
- In addition, 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.
- Performing other clerical tasks, as required.
Claims Processor Requirements:
- Medical Qualification Background will be an added advantage.
- At least 2 years of experience as a claim’s processor or in a related role.
- Knowledge of Medical Terminologies, CPT codes and ICD-9 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
Method of Application
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