Claims Senior Representative

hace 2 días


Pozuelo de Alarcón, Madrid, España The Cigna Group A tiempo completo
Job Description

Job Title: IOH Claims Senior Representative

Job Summary:

We are seeking a highly motivated and experienced Claims Senior Representative to join our team in Madrid. As a key member of our Operations Team, you will be responsible for delivering specific delegated Claims tasks assigned by a supervisor, examining and processing paper claims and/or electronic claims, and determining whether to return, pend, deny or pay claims within policies.

Main Responsibilities:

  • Provide coaching and development for Claims team staff
  • Review team performance and ensure coaching opportunities are identified
  • Ownership of BPO team scorecards, updating performance and ensuring coaching opportunities are identified when required
  • Quality Audit execution and reporting results, ensuring Quality Audit targets are achieved
  • Engage staff to create a dynamic working environment at all levels, supporting the team and the processes towards continuous improvement while supporting the change journey
  • Proactively optimize the unit's workflows to achieve set targets
  • Managing the senior queues daily
  • Monitoring and managing workflow to ensure TAT targets are achieved and inventory levels are managed
  • Instrumental in the Claims Processes to ensure risks are highlighted
  • 1st Point of contact for Escalations
  • Mainframe and financial transactions
  • Ad-hoc projects
  • As required, processing or verifying

Requirements:

  • 1 year experience in processing Provider claims
  • Ability to complete tasks with little or no supervision
  • Self-motivated with a proactive approach
  • Exceptional attention to detail and accuracy
  • Ability to take ownership
  • Demonstrated Coaching/Development Experience
  • Work well in a team environment
  • Computer literacy (especially Excel)
  • Ability to learn in a virtual environment
  • Excellent problem-solving skills
  • Confidentiality Management of Data
  • Leadership Skills will be a plus


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