Claims Resolution Specialist – Medical Insurance

Cigna Healthcare; Kuala Lumpur; On-site; MYR 39,000 - 61,000; Full time

Job summary

Cigna Healthcare in Malaysia is seeking a claims processing professional to support providers and members with claim processing, policy interpretation, and pre-approvals. The role emphasizes accuracy, timely processing, and collaboration across teams to resolve complex queries.

Responsibilities include handling inquiries via phone and email, maintaining authorization files, and ensuring adherence to policy terms while meeting productivity targets in a healthcare environment.

Responsibilities

• Processes claims from members and providers.
• Assists queries from providers and payers via phone calls or e-mails.
• Maintains files for authorizations and other reports.
• Assesses and processes claims in line with the policy coverage and medical necessity.
• Be fully versed with medical insurance policies for various groups / beneficiaries.
• May assist in training colleagues and asked to share knowledge.
• Accurately assesses eligibility within the policy boundaries.
• Monitors and maintains the claims processing as per the defined terms and policy of the organization.
• Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis.
• Monitors the qualitative and quantitative measures for claims & pre-approvals.
• Ensures compliance to any changes in terms of system parameters or process.
• Maintains quality as per framework for accuracy.
• Maintains productivity and responsiveness to the work allocated.
• Collaborate with other stakeholders / teams to resolve queries including complex queries.

Job description

Cigna Healthcare in Malaysia is seeking a claims processing professional to support providers and members with claim processing, policy interpretation, and pre-approvals. The role emphasizes accuracy, timely processing, and collaboration across teams to resolve complex queries.

Responsibilities include handling inquiries via phone and email, maintaining authorization files, and ensuring adherence to policy terms while meeting productivity targets in a healthcare environment.