Role summary

• The clinical value team is looking for 2 Medical Claims Review Senior Analysts (Band 3)
• As part of the Claims Review team you will be primarily responsible for the Medical Review, Coding, MNR and ICR of claims.

You will be:

• Interpreting key information from medical reports/invoices and translating this into medical coding in our hospitalization database and/or Salesforce application ‘Healthcloud’
• Analyzing invoices from providers all over the world to identify cost containment opportunities and you will be taking appropriate actions in line with our procedures to avoid unnecessary costs for our clients, members and Cigna
• Reviewing claims from a clinical point of view directly with Providers
• Collaborating with colleagues in different teams and roles (Claims Analysts, CSR’s, Doctors, Nurses etc) across the business while bridging cultural differences & backgrounds
• Attending weekly/Monthly/ad-hoc meetings with the team & supervisor to discuss and improve internal workflows and collaboration
• Serving as a contact person for other teams within Clinical and the wider business for expert advice on R&C calculations
• Taking ownership of your production making sure you meet the expected outputs

YOUR PROFILE

• Proficient in English
• Clinical Background (Nurse/Clinical officer)
• Passive knowledge of French/German/Italian. Additional languages is a plus
• Experience with processing provider claims is a plus
• Affinity with medical terminology is a plus
• ICD knowledge is a plus
• Communicative and not afraid to approach people
• Proactive and driven
• You can deal with integrity
• Tech savy, not afraid to work in/with different systems/applications at the same time
• Eye for detail and love for accurateness
• Flexible with the ability to shift priorities when required
• Not afraid of moving forward in the midst of ambiguity