Claims Representative - Provider Services

Cigna; Kempton Park; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A leading health services provider seeks a Claims Representative in Kempton Park, South Africa. Responsibilities include processing international medical claims, ensuring compliance with policies, and maintaining high service quality. Candidates must have a relevant bachelor's degree and proficiency in English, with additional languages preferred. The position requires strong decision-making abilities, attention to detail, and effective communication skills within a structured and high-volume environment.

Qualifications

• Proficiency in English required, additional languages (French, Portuguese) are a plus.
• Experience in a high-volume processing environment is beneficial.

Responsibilities

• Process provider claims efficiently with adherence to policy rules.
• Validate claim data across various platforms.
• Monitor claim trends and communicate issues effectively.

Skills

Decision making capability

Proficiency with numerical data

Teamwork orientation

High attention to detail

Education

Bachelor’s degree in Business, Mathematics, Economics, or Statistics

Job description

About the Role

The Claims Representative is responsible for accurate and timely processing of international medical claims from global providers, in line with contractual obligations, and standard operating procedures requirements. The role operates in a structured, high-volume environment and requires consistent judgement, disciplined process execution, and clear communication with internal stakeholders.

Responsibilities

• Process provider claims against policy and benefit rules, delivering decisions that meet quality and turnaround time standards.
• Validate and reconcile claim data across Administration, Workflow, and CRM platforms; ensure completeness, coding alignment, and internal consistency.
• Maintain full compliance with confidentiality, data protection, medical privacy, and audit documentation requirements.
• Identify and escalate claims issues in a concise context meeting both customer and provider satisfaction standards.
• Communicate relevant escalation updates to internal partners in a clear, structured, and timely manner.
• Monitor claim trends, anomalies, or workflow inefficiencies and communicate these to the Supervisor for action.
• Manage assigned claim queues proactively, maintaining throughput during routine and peak periods.
• Contribute to team cooperation, knowledge sharing, and a professional working environment.
• Execute any additional responsibilities assigned by the Supervisor.

Requirements

Education

• Bachelor’s degree in a Business, Mathematics, Economics, Statistics or related field.

Languages

• Proficiency in English required.
• Additional languages (French, Portuguese) are an added advantage.

Skills and Professional Attributes

• Strong decision making capability, with the ability to act based on available information.
• Proficiency working with numerical data and structured information.
• Ability to navigate multiple systems and adapt quickly to new tools and processes.
• High attention to detail, with consistent accuracy across repetitive tasks.
• Reliable adherence to processes, documentation standards, and audit requirements.
• Ability to sustain quality and productivity expectations in a high volume environment.
• Strong teamwork orientation and willingness to support colleagues when needed.
• Demonstrate discretion when handling confidential medical information.

Why Join

The Claims Representative plays a critical role in maintaining service quality for Medical Provider partners. Accurate, timely claim decisions strengthen operational integrity, ensure cost control, and support a consistent, reliable service experience. The role provides a structured environment where performance expectations are clear and where professionalism, accountability, and precision are valued from the outset.

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.