Case Management Associate Analyst at Cigna

Case Management Associate Analyst at Cigna,

Case Management Associate Analyst

Remote type: Hybrid
Locations: Kenya One Africa Place
Job Type: Full time
Job requisition id: 23014685

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 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.

To join our growing team in Nairobi, we are looking for a Case Management Associate Analyst to be part of our clinical team that provides medical management services to customers worldwide.
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
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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.

OUR OFFER

  • A challenging job in an international and growing enterprise.
  • A dynamic, young and entrepreneurial company culture that values and stimulates initiative.
  • Attractive salary conditions with extralegal benefits.

About Cigna Healthcare

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.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourselfEMEA@cigna.com for support. Do not email SeeYourselfEMEA@cigna.com for an update on your application or to provide your resume as you will not receive a response.