Clinical Claims Review Senior Analysts at Cigna

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