The incumbent will help with day-to-day communication with network providers for claims operations.  This includes communication regarding checking of benefit eligibility of members/customers via electronic feed, coordinating system testing with network providers when new system process launched and reconciliation of provider claims payment settlement via electronic mean. 

Job Responsibilities:

• Process medical Pre-approval and Claims in compliance with policy provision and benefits
• Handle case management for entire claims journey to customer
• Comply with medical guidelines and provide quality work effectively and efficiently
• Liaise with medical professionals and healthcare provider to conduct Pre-approval and Claims assessments or investigation  

• Handle related Pre-approval and Claims enquiries from customers, brokers or relevant parties
• Support manager to implement initiatives to improve claims performance     
• Maintain positive relationship with all stakeholders 

Job Requirements:

• Degree / Diploma holder or equivalent working experience
• At least 5 years of experience in medical Pre-approval and Claims processing
• Experience in handing medical Pre-approval and Claims
• Relevant medical knowledge is an advantage
• Customer-oriented with excellent communication and interpersonal skills.
• Strong team player, willing to learn, able to work independently and under pressure
• Good command of English and Chinese in both written and spoken
• Proficiency in MS Office applications including Word, Excel and Chinese word processing

About The Cigna Group