Pharma Claims Representative - Cigna Healthcare

Cigna; Bengaluru; On-site; INR 300,000 - 500,000; Full time

Job summary

Cigna Bengaluru is seeking a detail‑oriented Claims Processing Associate to join our international claims team. You will adjudicate pharmacy claims, monitor high‑cost cases, and ensure timely settlements while abiding by policy terms and regulatory requirements.

Applicants should have 1+ year in healthcare services or claims processing, with strong English communication, proficiency in MS Office, and a proactive approach to process improvement within a collaborative team.

Qualifications

• Graduate in medical, paramedical, pharmacy or nursing.
• Minimum 1 year of experience in healthcare services or processing healthcare claims.
• Expertise in international insurance claims processing.
• Working knowledge of the insurance industry and relevant regulations.
• Excellent English communication, both verbal and written.
• Proactive in meeting targets and multitasking.
• Ability to organise and manage workflow.

Responsibilities

• Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• Monitor and highlight high-cost claims and ensure relevant parties are aware.
• Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your Supervisor when this is not achievable.
• Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible.
• Interface effective with internal and external customers to resolve customer issues.
• Identify potential process improvements and make recommendations to team senior.
• Actively support other team members and provide resource to enable all team goals to be achieved.
• Work across International business in line with service needs.
• Carry out other ad hoc tasks as required in meeting business needs.
• Work cohesively in a team environment.
• Adhere to policies and practices, training, and certification requirements.

Skills

English communication

MS Office

Critical thinking

Attention to detail

Interpersonal skills

Customer focus

Process improvement

Time management

Healthcare claims experience

Education

Graduate in medical/paramedical/pharmacy/nursing

Job description

About Us

At CIGNA Healthcare we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities, and shareholders every day.

One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We are devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being.

CIGNA Healthcare believes both in the importance of working together and offering flexibility to our employees. We use a multi-faceted approach for flexibility, depending on the various roles in our organization.

Working at CIGNA Healthcare will give you a great career with opportunities to learn, grow and make an impact, along with the power to make a difference. Join us!

Process Overview*

International insurance claims processing for Member claims.

Job Description*

Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles.

Responsibilities: -

• Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• Monitor and highlight high-cost claims and ensure relevant parties are aware.
• Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your Supervisor when this is not achievable.
• Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible.
• Interface effective with internal and external customers to resolve customer issues.
• Identify potential process improvements and make recommendations to team senior.
• Actively support other team members and provide resource to enable all team goals to be achieved.
• Work across International business in line with service needs.
• Carry out other ad hoc tasks as required in meeting business needs.
• Work cohesively in a team environment.
• Adhere to policies and practices, training, and certification requirements.

Requirements*:

• Working knowledge of the insurance industry and relevant federal and state regulations.
• Good English language communication skills, both verbal and written.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Ability to meet/exceed targets and manage multiple priorities.
• Must possess excellent attention to detail, with a high level of accuracy.
• Strong interpersonal skills.
• Strong customer focus with ability to identify and solve problems.
• Ability to work under own initiative and proactive in recommending and implementing process improvements.
• Ability to organise, prioritise and manage workflow to meet individual and team requirements.
• Experience in medical administration, claims environment or Contact Centre environment is advantageous but not essential.

Education*:

• Graduate (Any) - medical, Paramedical, Pharmacy or Nursing.

Experience Range* :

• Minimum 1 year of experience in healthcare services or processing of healthcare insurance claims.

Foundational Skills*

• Expertise in international insurance claims processing

Work Timings*

• 7:30 am- 16:30 pm IST

Job Location*:

• Bengaluru (Bangalore)

About The Cigna Group

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.