Knowledge Management and Training

• Building and maintaining a solid in depth knowledge in COM and Call process by gaining insights in the ins and out of the call flow, so you can become the expert who can advise in tenders for example, or when implementing a new product or client
• Being an expert user of any of the used tools within the team
• Being the organizational ambassador for your knowledge area within your own team and across the wider organization.

• You are the go to person in case of questions on your area of expertise.
• Document controlling for procedures and processes that link to the process(Updating Knowledge Exchange)
• Provide support & assistance in Training new hires (work with trainer to define needs and delivery and organize training materials)
• Give training on Contracts, procedures and processes and systems
• Support and feedback to SV /Manager on the training
• Identify any training needs found within the department and address appropriately.

Projects & Continuous improvement

• Encouraging the implementation of any new processes, updating processes when necessary and follow up with necessary updates.
• Collaboration- Work with different team to improve the internal process and address the system limitation (SF –Defects; calls issues escalation) immediately with respective stakeholder.
• Being proactive in identifying improvement/enhancement opportunities and be active in seeking and sharing ideas for innovation in business processes.

People / Client /Customers

• Take complete ownership of customer contacts and ensure complete resolution
• Actively make recommendations / suggestions to help improve the customer experience.
• Continued focus on the delivery of NPS/Audits results by sharing results, feedback, data analysis, training and knowledge management.
• Embrace changes from NPS, quality audits and feedback taking personal ownership and seek ways to investigate ways to improve these areas, engage employees and improve metrics.
• Actively create and promote team engagement (recognition, communication, engagement events)

Reports :

• Familiar with contact centre reports and propose improvements based on the data.
• Familiar with Contact Center planning company call metrics, targets, call flows and possible impacts across locations.

YOUR PROFILE

• Strong performance track record
• International mind-set, with holistic attitude and able to work remotely with peers across locations
• 2 years of Cigna experience
• Good communication skills, and knowledge of Window tools, e.g. Excel , PowerPoint, Windows.
• A growth mind-set with a positive attitude towards change and the ability to play an active role in implementing change initiatives within your own process
• Action-orientated problem-solving attitude
• Able to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues
• Accountability – assume ownership for achieving personal results and collective team goals

Key to the role will be building/maintaining an in depth knowledge of Communication and Contact Centre process to continuously improve the processes and share that knowledge to deliver a high quality customer centric service offering.  Your role includes:

Knowledge Management and Training

• Building and maintaining a solid in depth knowledge in COM process
• Being an expert user of any of the used tools within the team
• Being the organizational ambassador for your knowledge area within your own team and across the wider organization.
• You are the go to person in case of questions on your area of expertise.
• Document controlling for procedures and processes that link to the process(Updating Knowledge Exchange)
• Provide support & assistance in Training new hires (work with trainer to define needs and delivery and organize training materials)
• Give training on Contracts, procedures and processes and systems
• Support and feedback to SV /Manager on the training
• Identify any training needs found within the department and address appropriately.

Projects & Continuous improvement

• Encouraging the implementation of any new processes, updating processes when necessary and follow up with necessary updates.
• Collaboration- Work with different team to improve the internal process and address the system limitation (SF –Defects) immediately with respective stakeholder.
• Being proactive in identifying improvement/enhancement opportunities and be active in seeking and sharing ideas for innovation in business processes.

People / Client /Customers

• Take complete ownership of customer contacts and ensure complete resolution
• Actively make recommendations / suggestions to help improve the customer experience.
• Continued focus on the delivery of NPS/Audits results by sharing results, feedback, data analysis, training and knowledge management.
• Embrace changes from NPS, quality audits and feedback taking personal ownership and seek ways to investigate ways to improve these areas, engage employees and improve metrics.
• Actively create and promote team engagement (recognition, communication, engagement events)

Reports :

• Familiar with contact centre reports and propose improvements based on the data.
• Familiar with Salesforce reports and support on TAT and Inventory management.

YOUR PROFILE

• Strong performance track record
• International mind-set, with holistic attitude and able to work remotely with peers across locations
• 2 years of Cigna experience
• Good communication skills, and knowledge of Window tools, e.g. Excel , PowerPoint, Windows.
• A growth mind-set with a positive attitude towards change and the ability to play an active role in implementing change initiatives within your own process
• Action-orientated problem-solving attitude
• Able to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues
• Accountability – assume ownership for achieving personal results and collective team goals

Handle calls and e-mails and respond to simple and complex inquiries regarding eligibility, cards status, Envoy registration/navigation, policy benefits, issue certificates of insurance, claims status and other related information and provide solutions for customers and clients.

Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, clients, brokers and/or others.  Performs research to respond to inquiries and interprets policy provisions to determine most effective response. Mails or routes claim forms and supporting documentation to various units for final processing. Excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity. May seek assistance with complex customer services issues.

Qualifications

• High School Diploma or equivalent required, Associates or Bachelor’s degree preferred
• Excellent English written and oral communication skills
• Fluency in written and spoken Portuguese is a PLUS
• Exceptional organizational and time-management focus
• Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
• 1+ years of customer service experience analyzing and solving customer problems required; call center experience a PLUS
• Ability to perform in a high volume, fast paced call center environment
• Proven ability to work independently as well as a productive member of a team
• Intermediate proficiency in Microsoft Office Suite; high level capacity to multitask independently and on a computer
• Knowledge of Medical Terminology a PLUS

Conditions/Requirements:

• Work in 24 x 7 rotation shifts.
• 5 days a week.
• In split shifts (some hours in the morning and remaining hours in the afternoon or evening)
• During public holidays

YOUR JOB

As a supervisor you will support the team manager in managing a team of Claims Analysts.  Key to the role will be developing and coaching the team to deliver a high quality customer centric service offering.  Your role includes:

• Accountable to review and assess inventory levels co-ordinating daily allocations and planning ahead to maximise staffing levels to maximise results. 
• Accountable to ensure that productivity, quality and customer satisfaction, are managed within own team and motivation of the individuals and team to achieve the operational KPI’s; Attending KPI calls can help you to achieve this.
• Recommending and implementing innovative strategies to improve efficiency and provide excellent customer service
• Being proactive in identifying improvement/enhancement opportunities and be active in seeking and sharing ideas for innovation in business processes.
• Being responsible for follow-up of capacity planning and absences in close cooperation with HR
• Ensure strong employee engagement within the team, including day to day oversight, motivation, conflict management, training, well-being and performance by providing coaching and skill development in collaboration with the Claims Management Team.
• Ensure appropriate performance management actions are taken
• Having quarterly check-in conversations with all team members
• Promote a culture of continuous improvement and be fully responsible for the implementation of new ways of working and the measurement of the results in alignment with the broader Claims Strategy and in coordination with the Management Team
• Taking ownership of any escalated claims and provide updates to the Team manager on any issues
• Proactively address and/or escalate any operational risks to the team Manager
• Developing/maintaining proactive/effective business relationships, both internally and externally to ensure a seamless delivery of service.  Actively encourage all team members to do likewise (e.g. Cigna links).
• Option to take over SPOC role for particular clients/accounts if required
• Represent the Organisation during client visits, absences, stakeholder meetings, or act as a relationship person towards some our strategic partners.
• Together with the SME, you are responsible and accountable for the implementation of new clients/renewals/changes for existing clients that belong to your book of business               
• Process claims or support the financial verification

YOUR PROFILE

• Strong performance track record
• International mind-set, with holistic and able to work remotely with peers across locations
• 2 years of Cigna eperience, or relevant leadership experience in other functions/companies
• Experience in and passion for coaching, managing, developing and motivating individuals and the team.
• Experience in complaint management - with a proven track record in improving customer service standards
• Strong presentation skills, and knoweldge of Window Office tools like Word, Outlook, Excel, Powerpoint...
•  A growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives.
• Excellent interpersonal skills: strong empathy and listening skills, strong articulation and communciations skills
• Striving for excellent service to our members, clients and providers is part of your DNA.
• Competency to build a team and create an atmosphere of positive collaboration, innovation and creative solutioning among the team members
• Action-orientated problem-solving attitude
• Excellent organisation, planning and prioritisation skills
• Able to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues
• Results orientated – ability to cascade and explain goals, establish plans and manage work to achieve desired outcomes. Create meaningful business related metrics and track progress/results
• Accountability – assume ownership for achieving personal results and collective team goals

YOUR JOB

The clinical CARE team is looking for a Medical Claims Review Associate Analysts (Band 2). As part of the claims review team you will be responsible for the medical coding and cost review of all IO Inpatient Provider claims.

You will be:

• Interpreting key information from medical reports/invoices and translating this into medical coding in our hospitalization database and/or Salesforce application ‘Healthcloud’
• Analyzing invoices from providers all over the world to identify cost containment opportunities and you will be taking appropriate actions in line with our procedures to avoid unnecessary costs for our clients ,members and Cigna
• Collaborating with colleagues in different teams and roles (Claims Analysts, CSR’s, Doctors, Nurses etc.) across the business while bridging cultural differences & backgrounds
• Connecting with providers to obtain (additional) medical information
• Attending weekly/Monthly/ad-hoc meetings with the team & supervisor to discuss and improve internal workflows and collaboration
• Serving as a contact person for other teams within Clinical and the wider business for expert advice on R&C calculations
• Taking ownership of your production making sure you meet the expected outputs

YOUR PROFILE

• Proficient in English
• Active or passive knowledge of French/German/Italian. Additional languages are a plus
• Experience with processing provider claims
• Clinical background is a plus
• Communicative and not afraid to approach people
• Proactive and driven
• You can deal with integrity
• Tech savvy, not afraid to work in/with different systems/applications at the same time
• Eye for detail and love for accurateness
• Flexible with the ability to shift priorities when required
• Not afraid of moving forward in the midst of ambiguity

OUR OFFER

• A permanent job in an international and growing enterprise
• A nice team of enthusiastic and diverse CARE team members in different work locations
• A dynamic, young and entrepreneurial company culture that values and stimulates initiative
• Flexible working hours with the opportunity to work from home