Case Management Associate Analyst

Cigna Healthcare; Kuala Lumpur; On-site; MYR 40,000 - 60,000; Full time

Job summary

Cigna Healthcare in Malaysia seeks a key person for CARE Coordination IOH files, working with internal and external parties. You will communicate with health care providers to obtain medical and administrative information and stay in close contact with insured patients.

You will negotiate costs with providers, steer patients to the right care, and coordinate with Claims Review and other departments. Strong English is essential; French is a plus, and travel within Asia may be required.

Qualifications

• Must have 1 year in IOH Care Team and 1 year in current role.
• English language is essential.
• French is an asset.

Responsibilities

• Communicate with health care providers to obtain medical and administrative information.
• Maintain contact with insured/patients and comfortable calling.
• Coordinate with client organizations when needed.
• Negotiate high costs with providers and doctors.
• Direct patients to appropriate care givers and services.
• Contribute to cost containment with Claims Review colleagues.
• Collaborate with Network, Fraud Waste and Abuse, and Clinical Case Management teams.
• Register cost containment achievements in dedicated tools.
• Clarify files to authorized parties.
• Issue GOP in complex files.
• Coordinate out-of-country care files and evacuations, mainly in Asia region.

Skills

Negotiation skills

Coordination skills

Written communication

Customer-focused

Discretion

Team player

English fluency

French asset

MS Office

Proprietary IT system

Tools

MS Office

Proprietary IT system

Job description

Job Description :

You are the key person for CARE Coordination files IOH , where you are working together with all parties involved, internal as well as external. This implies that:

• you take care of the communication with health care providers in order to obtain all the necessary (medical and administrative) information;
• you are in close contact with the insured/patient (i.e. comfort calling);
• you will contact the client’s organization if needed;
• you negotiate high costs with providers and doctors,
• you steer patients to the right care giver,
• you explore cost containment opportunities together with the colleagues from Claims Review;
• you work closely with the other organizations (i.e. Network, Fraud Waste and Abuse, Clinical Case Management);
• registering cost containment achievements in dedicated tools and formats,
• clarifying files to authorized parties;
• Issuance of guarantee of payments (GOP) in complex files.
• You coordinate out of country care files and Evacuations mainly is Asia Region, together with other Cigna departments and external assistance providers.
• All our clients and healthcare providers are internationally located. Therefore you manage the English language well, both spoken and written.

Profile:

Active and fluent in at least English any other language is an asset (French is highly recommended) .

At least 1 year experience in IOH Care Team and 1 year in current role completed is a MUST.

• Strong negotiation skills, (i.e. a strong focus on cost containment without never losing sight of commercial benefits and maintaining provider relationships),
• Strong coordinating skills (i.e. accurate, efficient, assimilate different information, critical, negotiating, communicative, skilled decision maker, …)
• Written skills: conveys messages in clear language, paying attention to accent/circumstances
• and appropriate style
• Customer-focused: communicates empathically
• Accurate: works accurately by giving complete and correct answers
• Responsible: ensures that assigned contracts are followed up in a diligent, timely and accurate manner.
• Disciplined: follows procedures, agreements and document flows correctly
• Efficient: able to strike the right balance between quality and quantity
• Team-player: enjoys working as part of a team
• Discrete: exercises utmost discretion when dealing with confidential (medical) information Specific Knowledge:
• Use of necessary reference works
• Knowledge of Microsoft Office- and proprietary IT application

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.