Claims Representative

Cigna Healthcare Africa is an insurance company founded in 1982, operating in the healthcare and pharmaceutical sectors.

The position involves processing claims for an insurance team. To be successful as a claims processor, you should have excellent organizational and interpersonal skills, be able to work under pressure, and perform a range of clerical functions with great attention to detail.

1. Validate the information on all medical claims from patients seeking payment from their insurance company.
2. Thoroughly review claims to ensure that there is no missing or incomplete information.
3. Keep meticulous records of claims and follow up on lapsed cases.
4. Record and maintain insurance policy and claims information in a database system.
5. Determine policy coverage and calculate claim amounts.
6. Process claims payments.
7. Answer queries related to Policy coverage criteria and guidelines.
8. Comply with federal, state, and company regulations and policies.
9. Approve or deny payment to doctors by correctly reading and assessing medical documents.
10. Converse with doctors’ offices or insurance companies if there is a problem with the claim.
11. Perform other clerical tasks, as required.

1. Medical Qualification Background will be an added advantage.
2. At least 2 years of experience as a claims processor or in a related role.
3. Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.
4. Working knowledge of the insurance industry and relevant federal and state regulations.
5. Computer literate and proficient in MS Office.
6. Excellent critical thinking and decision-making skills.
7. Good administrative and organizational skills.
8. Strong customer service skills.
9. Ability to work under pressure.
10. High attention to details.
11. Bachelor Degree.