Job Purpose:

The incumbent will help with day-to-day pre-approval and related claims settlement, and communication with member and network providers for claims operations. This includes communication regarding delivery of approval result and proper documentation, and follow up of network case claims settlement.

Critical Tasks and Expected Contributions / Results:

• Handle pre-approval of commercial assessment

• Handle claims process, including pre-approval case, inpatient and outpatient claim

• Communicate with customer on pre-approval decision

• Improve the effectiveness of the claim adjudication and administration processes of network service providers

• Handle provider claim enquiries from panel network

• Prepare report to management on metrics relating to pre-approval and related claims.

• Evaluate and gather all data for claim processes, conduct claim investigation and to review all status and ensure efficient adjustment in claim system.

• Meet standard of individual quality, turnaround time and productivity benchmark.

Experience / Knowledge, Education and Other Requirements:

• Diploma or above, preferably with insurance-related qualifications, e.g. FLMI, ICA

• At least 3 years’ experience in claims adjudication / administration

• Experience in working with pre-approval of medical claims

• Good team player, able to work independently and under pressure in a fast-paced environment

• Possess customer centricity mindset

• Good interpersonal and communication skills

• Cantonese speaker with good command of both English and Chinese

About The Cigna Group

Cigna 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.