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JOB PURPOSE

Manages the accurate and timely adjudication of claims and administers disposition according to contractual benefits and company procedures. Provides direction and guidance regarding policies, procedures, workflows, claim service quality, and training needs. Responsible for monitoring claim service standards.

2. RESPONSIBILITIES AND DUTIES

• Serve as a single point of contact for customer base to manage account, trend issues and develop action plans for improvement.

• Regularly meets with customers to discuss results and issues.

• Communicates and educates regarding issues/trends to minimize errors.

• Conduct client presentations to review site operations and answer service questions regarding hiring and training of staff, roles and responsibilities of functional areas etc.

• Monitors Performance Guarantees to minimize financial impacts.

• Monitor team member key performance metrics and take actions to improve continually.

• Build & maintain good relationships with clients, brokers and colleagues

• Hold weekly meeting with your team and provide proactive feedback to team members.

3. KNOWLEDGE, SKILLS AND EXPERIENCE

• 5 or more years of experience in benefits and claims administration with three or more years of management experience.

• Fluent in both spoken and written English.

• Preferable insurance background.

• Strong interpersonal skills with good verbal and written communication to internal and external client.

• Solid knowledge of basic Microsoft applications to include Word, Excel, MS Outlook and PowerPoint.

• Data driven management capability.

• Strong interpersonal skills with good verbal and written communication.

• Strong customer focus with ability to identify and solve problems.

• Ability to work under own initiative and proactive in recommending and implementing process improvements. Statements in this Job Description are intended to reflect, in general, the duties and responsibilities of the position, but they are not to be interpreted as totally inclusive. Cigna is an equal opportunity employer.

• Ability to organize, prioritize and manage workflow to meet individual and team requirements.

• Broad awareness of medical terminology, advantageous.

• Excellent organizational skills, capable of following and contributing to agreed procedure.

• Strong administration awareness and experience, essential.

• Strong skills in Microsoft Office applications, essential.

• Flexible and adaptable approach, sometimes working in a fast-paced environment.

• Passion for achieving agreed objectives.

• Should be flexible to work in shifts and on staggered weekends

4. COMMUNICATIONS AND WORKING RELATIONSHIPS

The job holder develops effective relationships and communications with team members. He/She clearly communicates goals, concepts, processes to a wide audience by tailoring levels of communications to audience.

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.