Reconciliation Agent - Cigna Healthcare

MY1 Cigna International Health Services Sdn Bhd; Kuala Lumpur; Remote; MYR 60,000 - 82,000; Full time

Job summary

Cigna Health and Life Insurance Company is seeking a Provider Reconciliation Agent to join the Global Provider Reconciliation (GPR) Team within Provider Services. You will review reconciliation requests from providers on paid medical claims and investigate bill statuses using Cigna payment systems.

You will coordinate with other departments, monitor communications with global facilities, and support team goals while seeking process improvements and meeting KPIs.

Qualifications

• At least 1 year of experience in a customer service role.
• Good English language skills; additional language a plus.

Responsibilities

• Review reconciliation requests from providers using relevant systems.
• Investigate case statuses and coordinate with other teams to resolve cases.
• Follow up to help facilities interpret feedback and take steps.
• Manage incoming/outgoing communications with providers globally.
• Handle intake of reconciliation cases, including upload and prioritization.
• Support GPR team to achieve goals and propose process improvements.
• Provide feedback on urgent or critical cases needing action.
• Deliver on KPIs in production, quality, and turnaround time.

Skills

Customer service

English proficiency

Remote work mindset

Attention to detail

Time management

Interpersonal skills

SharePoint

Microsoft Office

Tools

SharePoint

Microsoft Office

Job description

YOUR JOB

As a Provider Reconciliation Agent you will be part of a Global Provider Reconciliation (GPR) Team embedded into the Provider Services department. Your main responsibilities will be related with review of the reconciliation requests from providers on the paid medical claims where you would need to investigate the status of a certain bill using Cigna relevant payment systems. For some specific cases you would be in contact with different departments within Cigna to take necessary steps in order to resolve the reconciliation cases according to the established timeframe. Apart from this you will be monitoring the incoming/outgoing communications with our globally distributed medical facilities as well as be a point of contact for other departments with any provider claims related queries.

YOUR role includes

• You will be responsible for the initial review of the reconciliation requests received from providers using relevant supporting systems;
• Performing deeper investigation on certain cases together with further coordination with other teams in order to solve the cases according to the established standards;
• As part of the reconciliation review, you will be following up on the cases where additional support is needed to help the facility interprete our feedback and take necessary steps;
• Managing the incoming and outgoing communications with our providers globally and handling the internal requests related to provider inquiries;
• Performing the intake process of the reconciliation cases which will include upload, priority setting and close follow up on the completion;
• Actively support other GPR team members and provide help to enable team goals to be achieved;
• Being able to identify any process improvement and make recommendations for potential changes;
• Provide feedback to the GPR team on urgent or critical cases that need special action or attention;
• Deliver on operational KPI’s within the GPR team in terms of production, quality, TAT, amongst others;

YOUR PROFILE

• At least 1 years of experience in a customer service role;
• Good English language skills, additional language is a plus;
• International mind-set able to work remotely with colleagues, partners and providers across the globe;
• Striving for excellent service to our members, clients and providers is part of your DNA;
• Detail oriented with high accuracy level and proven time management and organization skills (including the ability to engage in multiple tasks and meet deadlines/standards);
• Act with a sense of urgency to research questions or issues brought by different teams. Identify the right parties or resources to resolve these issues;
• Strong customer focus with ability to identify and solve problems;
• Strong interpersonal skills with good verbal and written communication to internal and external parties;
• Be a positive role model and have the ability to work independently and in conjunction with co-workers of all levels;
• A growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives;
• Accountability – to assume ownership for achieving personal results and to contribute for collective team goals;
• Working knowledge of SharePoint & Microsoft office;

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. Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.