Claims Senior Representative

hace 7 días


Madrid, Madrid, España The Cigna Group A tiempo completo
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 Claims Organization, you will be responsible for delivering delegated Claims tasks assigned by a supervisor. Your primary focus will be on examining and processing paper claims and/or electronic claims, determining whether to return, pend, deny or pay claims within policies. You will also be responsible for determining steps necessary for adjudication, following established departmental policies and procedures, and resolving claims and claims issues. Additionally, you will interact with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.

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, supporting the team and the processes towards continuous improvement. Proactively optimize the unit's workflows to achieve set targets, manage the senior queues daily, and monitor and manage workflow to ensure TAT targets are achieved and inventory levels are managed.

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, and confidentiality management of data.

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