Career Opportunity for MBBS Candidates: Medical Claims Review Senior Analyst Job at Cigna- Apply Now
Looking to advance your career in medical claims review? Cigna Healthcare, a division of The Cigna Group, is hiring a Medical Claims Review Senior Analyst/Clinical Supervisor for its Complex Claim Unit. This role involves evaluating high-dollar and complex claims, ensuring compliance with reimbursement policies, and identifying fraud and billing errors. If you have a strong background in health care reimbursement, quality assurance, and clinical expertise, this is your chance to make a meaningful impact. Apply today!
Job Posting: Medical Claims Review Senior Analyst/Clinical Supervisor – Complex Claim Unit
Provides clinical review expertise for high-dollar and complex claims, including facility and professional bills. Provides cost containment services by identifying coding and billing errors and ensuring the application of Medical and Reimbursement Policies. Additionally, it identifies cases of potential fraud and abuse and makes referrals.
Major Job Responsibilities
- Evaluates medical information against criteria, benefit plan, and coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met
- Evaluate itemized bills against reimbursement policies
- Adheres to quality assurance standards
- Handles some escalated cases; secures supervisory assistance with problem solving and decision making
- Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals
- Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally
Qualifications
- MBBS or BSc/MSc Nursing.
- Maintain active Medical/nursing license as required by state and company guidelines
- Clinical experience in hospital/clinic for 2 or more years
- Team player
- Flexible/Adaptable
- Excellent time management, organizational, and research skills
Key Skills and Competencies
- Strong background in quantitative decision making, ability to drive business/operations metrics
- Metrics-driven. Able to translate strategy into measurable operational goals and objectives. Disciplined in assessing performance and addressing problems.
- Good communication and strong interpersonal skills
- Highly organized, structured & proactive
- Good inter-cultural skills & Exposure to global work environment
- Good time management skills – meet tight timelines and manage ad hoc deliverables, if any
