Cigna Care Associate Jobs in Kenya

Cigna Care Associate Jobs in Kenya

Cigna is one of the world’s leading providers of health care, expatriate employee benefits, life, accidental and supplemental health insurance. Headquartered in the US and listed in NYSE, the Company operates in countries across the Americas, Europe, Africa and Asia Pacific.

Cigna Global Health Benefits (CGHB) is an integral part of Cigna's growing international businesses. Product types include Medical, Dental, Vision, Life, AD&D, Disability, Travel, etc. sold to groups and individuals. We have approximately 1 million medical members around the world.

Major Responsibilities

Part of a clinical team that provides medical management services to customers worldwide but mainly in Africa region.

Give evidence-based advice on pre-authorization, considering internationally accepted protocols and local and/or regional customs and regulations.

Assessing pre-authorization requests claims in line with the policy coverage and medical necessity.

Identify and refer cases to the Cigna Clinical team for case management, disease management and other clinical services

Assist and support the team in cost containment, assist in projects and service delivery to meet goals.

To assist queries from providers and payers via phone calls or e-mails

Be fully versed with medical insurance policies for various groups / beneficiaries.

Might be required to assist in training colleagues and sharing knowledge.

Ability to review, investigate, and respond to external and internal inquires/complaints and provide guidance to other clinical and non-clinical staff related to medical necessity.

Assist in fraud detection

Meeting the defined qualitative and

quantitative key performance metrics for the assigned job role.

Ensure adherence to the predefined TATs for pre-approvals

Achieving required targets assigned by the team leader on daily, weekly, and monthly basis.

Ensure compliance to any changes in terms of system parameters or process.

Other duties as assigned

Requirements

University degree of Medical /Nursing specialization with international healthcare experience.

2-3 years of clinical experience preferable in a payer setting on medical management.

Experience in the Africa region & International market

Fluent in English along with either French, Portuguese or Spanish, any other language is a plus

Strong interpersonal and communication skills.

Must be a computer literate

Knowledge of utilization, cost containment services, insurance coverage.

Ability to build solid working relationships with staff, clients, customers, and healthcare providers.

Demonstrates pro-active problem-solving and analytical skills

Ability to work under pressure and meet tight deadlines

Flexible to work on shifts/varying work schedules.


How to Apply

For more information and job application details, see; Cigna Care Associate Jobs in Kenya

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