Care Associate Analyst

Cigna; Kempton Park; Hybrid; ZAR 200 000 - 300 000; Full time

Job summary

A global health insurance provider is seeking a Care Associate Analyst to review and approve medical services while ensuring customers receive the best quality care. This role involves giving evidence-based advice on pre-authorization requests and assisting with fraud detection. The ideal candidate has a University degree in medical specialization and 2-3 years of clinical experience. Fluency in English and other languages is required. The position offers a competitive package, benefits, and a hybrid working model.

Benefits

Challenging job in an international environment

Dynamic company culture

Competitive package and benefits

Qualifications

• 2-3 years of clinical experience, preferably in a payer setting.
• Experience in the Africa region & International market.
• Knowledge of utilization and insurance coverage.

Responsibilities

• Review and approve medical services according to guidelines.
• Provide evidence-based advice on pre-authorization.
• Assist in fraud detection and meet key performance metrics.

Skills

Fluent in English

Interpersonal skills

Problem-solving skills

Communication skills

Education

University Degree or Diploma in Medical specialization

Tools

Computer literate

Job description

Cigna offers health insurance policies around the world. We are passionate and driven in helping people to improve their health, well-being, and sense of security. We started more than 200 years ago and since then we have continued to innovate and expand. At Cigna Health Benefits we focus on the unique needs of intergovernmental (IGO) and non-governmental (NGO) organizations, and expats from multinationals in Europe and Africa.

You can read a lot more about Cigna at www.cignahealthbenefits.com

We are seeking a Care Associate Analyst to join our expanding team in Nairobi.

Role Purpose

Responsible to review and approve medical services requested by providers or customers according to medical necessity review guidelines. Will ensure customers receive the best quality care, diagnostics and treatment and avoid over or under-utilization of clinical services. Ability to review, investigate and respond to external and internal inquiries/complaints. Provide guidance to other clinical and non-clinical staff related to medical necessity.

• Part of a clinical team that provides medical management services to customers worldwide but mainly in Africa region.
• Give evidence-based advice on pre-authorization, considering internationally accepted protocols and local and/or regional customs and regulations.
• Assessing pre-authorization requests claims in line with the policy coverage and medical necessity.
• Identify and refer cases to the Cigna Clinical team for case management, disease management and other clinical services.
• Assist and support the team in cost containment, assist in projects and service delivery to meet goals.
• To assist queries from providers and payers via phone calls or e-mails.
• Be fully versed with medical insurance policies for various groups / beneficiaries.
• Might be required to assist in training colleagues and sharing knowledge.
• Ability to review, investigate, and respond to external and internal inquires/complaints and provide guidance to other clinical and non-clinical staff related to medical necessity.
• Assist in fraud detection.
• Meeting the defined qualitative and quantitative key performance metrics for the assigned job role.
• Ensure adherence to the predefined TATs for pre-approvals.
• Achieving required targets assigned by the team leader on daily, weekly, and monthly basis.
• Ensure compliance to any changes in terms of system parameters or process.
• Other duties as assigned.

REQUIREMENTS

• University Degree or Diploma in Medical specialization.
• 2-3 years of clinical experience preferable in a payer setting on medical management.
• Experience in the Africa region & International market.
• Fluent in English along with either French, Portuguese or Spanish, any other language is a plus.
• Strong interpersonal and communication skills.
• Must be a computer literate.
• Knowledge of utilization, cost containment services, insurance coverage.
• Ability to build solid working relationships with staff, clients, customers, and healthcare providers.
• Demonstrates pro-active problem-solving and analytical skills.
• Ability to work under pressure and meet tight deadlines.
• Flexible to work on shifts/varying work schedules.

OUR OFFER

• A challenging job in an international environment
• A dynamic, young, and entrepreneurial company culture that values and stimulates initiative
• A competitive package and benefits
• Hybrid model of working
• Flexible working hours.

About Cigna Healthcare

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.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email [e-mail] for support. Do not email [e-mail] for an update on your application or to provide your resume as you will not receive a response.