Provider Claims Representative

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Job Description Summary

We are seeking a detail-oriented professional to deliver administrative and business services within the Claims department. This role involves examining and processing paper and electronic claims, determining whether to return, pend, deny, or pay claims in line with company policies. You will adjudicate claims, settle with claimants according to policy provisions, and verify completeness and validity by comparing applications and provider statements with policy files and records.

You will interact with agents and claimants via mail to correct errors, resolve omissions, and investigate questionable entries. Most issues are routine in nature. A solid understanding of claims processes and operating procedures is essential. Work is performed under clearly defined guidelines and close supervision.

ABOUT US:

Cigna Corporation is a global health service company dedicated to improving the health, well-being, and peace of mind of those we serve. We provide healthcare products and services, as well as group disability, life, accident, and international insurance—directly to individuals and through employers and intermediaries.

YOUR MISSION:

Perform critical analysis and processing of medical expense claims within established turnaround times.

Key Responsibilities

Claims Processing

• Assess and process medical expense claims while maintaining strict medical confidentiality.

• Ensure accurate data entry into PC and mainframe applications.

• Apply analytical and critical thinking in cost management and process optimisation.

• Monitor workload to maintain chronology and processing timelines, taking corrective action as needed.

• Collaborate with the Supervisor on unclear claims and suggest process improvements.

• Strive for high-quality claims handling, accurate reimbursements, and timely transactions.

Collaboration

• Communicate dossier details accurately to internal stakeholders.

• Identify procedural irregularities and escalate to the Supervisor.

• Raise concerns or sensitivities promptly.

• Contribute to a positive and cooperative team environment.

Skills and Knowledge

Education

• Degree or equivalent experience (e.g., accountancy, mathematics, foreign languages, administration).

Languages

• Proficiency in English is required.

• Knowledge of additional languages such as Russian, Polish, Chinese, German, Dutch, French, Italian, Portuguese, or other European and Asian languages is an advantage.

Core Skills

• Decision-making: Ability to take appropriate action based on available information.

• Numerical aptitude: Comfortable working with numbers.

• Accuracy: Committed to error-free data input.

• Discipline: Adheres to procedures and document flows.

• Efficiency: Balances quality and productivity effectively.

• Teamwork: Works collaboratively within a team.

• Technical skills: Quick to learn and use office applications.

• Discretion: Handles confidential medical information responsibly.

What We Offer

• Long-term contract

• Hybrid working model: Work from home 4 days per week and 1 day from our Madrid office (shuttle bus provided).

• Flexible start times: Choose between 07:00 and 09:30 (Monday to Friday, morning intensive shift).

• Comprehensive benefits: Private medical and dental insurance, life assurance, educational development programmes, foreign language scholarships, and flexible compensation options.

Please note that you must meet our posting guidelines to be eligible for consideration.  Policy can be reviewed at this link.