11 jobs in The Cigna Group

The candidate will be responsible for providing compliance, privacy and regulatory support to
Cigna International Health Services Kenya.
This position will be based in Nairobi, Kenya and will report to Head of Legal & Compliance, MEA.

Key Responsibilities

• Advise business units on a broad range of compliance and privacy matters, including identifying areas of risk and provide guidance to minimise compliance risks.
• Working closely with Cigna Kenya site lead to foster a culture of compliance within the organisation
• Participate and assist in any ad-hoc matters and projects as assigned by the Management or the TBC to ensure regulatory requirements are taken into consideration.
• Advise on data protection queries, policies and practices.
• Perform data protection impact assessment and develop data breach management plan in the event of breaches.
• Maintain awareness of industry trends on regulatory compliance and emerging threats. Continuously monitor and review any new laws and regulations, including any directives, notices, guidelines, codes, circulars, practice notes etc. issued by relevant authorities which are relevant to Cigna Kenya's business and to ensure that the company's practices comply with the foregoing.
• Coordinate corporate compliance strategy and implementation in cooperation with Cigna Kenya and Cigna International Market Compliance teams.
• Collaborate with Cigna Kenya site lead and other departments to create culture of compliance.
• Analyse and evaluate internal processes and procedures and provide recommendations to improve workplace compliance, as well as the performance of compliance investigations, monitoring and due diligence activities.
• Assist with the development and implementation of internal compliance policies and procedures.
• Oversee global sanctions screening processes being performed by Cigna Kenya
• Perform horizon scanning for Cigna Kenya
• Liaise with relevant authorities with regards to various compliance affairs, including completing forms for submission to relevant authorities, assisting with necessary filings and obtaining and maintaining any data privacy registrations with the Office of Data Protection
• Maintain the AML/CFT framework and ensure alignment with requirements as prescribed by relevant authorities which are relevant to Cigna Kenya's business.
• Prepare regular compliance, risk management, outsourcing and privacy-related reports, including regular risk assessment and compliance testing.
• Develop and maintain the 'Record of Processing Activities' (ROPA) for Cigna Kenya
• Provide support to the Cigna Information Protection team where necessary
• Provide relevant compliance and data protection training to internal stakeholders.

Requirements

• Degree educated
• 6 - 7 years of relevant compliance experience with at least 5 years in a regulated environment (preferably in the insurance industry)
• Ability to perform independently and a good team player.
• Consistently displays strong integrity and ethics
• Strong analytical skills, solution-oriented and a commercial mind with an eye for detail.
• Proactive and flexible individual with a structured approach to tackle problems.
• Possess good planning, organisational and time management skills.
• Ability to work under pressure in a fast-paced and dynamic environment while handling multiple competing tasks simultaneously to closure.
• Good communication and interpersonal skills, with the ability to work with people at all levels.
• Good command of written and spoken English.

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

The Position
International Health, a division of Cigna Healthcare, is a leading provider of group healthcare plans for employees of large multinational organisations and their families. With our continuing global expansion Cigna has an excellent opportunity for an enthusiastic, highly motivated and driven individual to join our Eligibility Team.

This role will be reporting to the Eligibility Supervisor.

Main Duties/Responsibilities

• Database Entry and/or Database Management experience essential.
• Process requests from internal and external customers reviewing the request and taking the appropriate action, in a timely and accurate manner.
• Internal and external clients depend on our accuracy and efficiency when processing client data, so you will be accountable for providing these high levels of service in accordance with the company standards and customer expectations.

Your Profile

• Strong interpersonal skills with excellent written/verbal communication skills
• Must possess excellent attention to detail, with a high level of accuracy
• Must be able to review information and exercise judgement
• Ability to organise, prioritise and manage workflow to meet individual and team production standards
• Ability to work under own initiative
• Customer focused with developed problem-solving abilities and a proactive approach to proposing/implementing process improvements
• Good analytical skills
• Ability to navigate systems and applications with ease
• Regulatory awareness
• Ability to work within a large team
• Adaptable to change with a flexible approach to supporting team tasks
• Proficient in Microsoft Word, Excel and Outlook – advanced Excel would be advantageous
• Minimum of a diploma, bachelor's degree or higher qualification is required.
• Experience from an insurance background preferred
• Spanish Speaking/Reading/Writing would be advantageous

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

You will be responsible for preparing claim forms, verifying information, and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.

To be successful as a claim's processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.

Main Duties / Responsibilities

• A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
• Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
• In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
• Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claims payments.
• Answering queries related to Policy coverage criteria and guidelines.
• Complying with federal, state, and company regulations and policies.
• Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
• Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.
• Performing other clerical tasks, as required.

Claims Processor Requirements

• Medical Qualification Background Diploma or Degree level is a requirement.
• At least 2 years of experience as a claim's processor or in a related role.
• Knowledge of Medical Terminologies, CPT codes and ICD-9 codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

Job Description Summary
Delivers straightforward administrative and/or other basic business services in Customer Service. Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, providers and/or others for information and assistance. Performs research to respond to inquiries and interprets policy provisions to determine most effective response. Mails or routes claim forms and supporting documentation to various units for final processing. Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity. Issues tend to be routine in nature. Good knowledge and understanding of Customer Service and business/operating processes and procedures. Works to clearly defined procedures under close supervision.

What are your main responsibilities?

• You are responsible for the client communication for designated account relationships and Contracts.
• You are required to response to the client on timely manner providing full and accurate information in one go.
• Handle calls and e-mails and respond to simple and complex inquiries regarding eligibility, cards status, envoy registration/navigation, policy benefits, issue certificates of insurance, claims status and other related information and provide solutions for customers and clients.
• Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, clients, brokers and/or others.
• Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
• Mails or routes claim forms and supporting documentation to various units for final processing.
• Excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints, or appeals ranging from routine to moderate complexity.
• May seek assistance with complex customer services issues.

Qualifications

• Must have a diploma or bachelor's degree certificate
• Excellent English written and oral communication skills
• French written and oral skill is a must
• Exceptional organizational and time-management focus
• Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
• 1+ years of customer service experience analyzing and solving customer problems required; call center experience a plus
• Ability to perform in a high volume, fast paced call center environment
• Proven ability to work independently as well as a productive member of a team
• Intermediate proficiency in Microsoft office suite; high level capacity to multitask independently and on a computer
• Knowledge of medical terminology a plus

Conditions/requirements

• Work in 24 x 7 rotation shifts.
• 5 days a week.
• In split shifts (some hours in the morning and remaining hours in the afternoon or evening) and public holidays

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

The Medical Advisor is a member of the medical team, part of IHT, who develops and manages health and wellness programs for Cigna customers. Together with a team of nurses and physicians she/he will ensure attainment of quality, production, timeliness, customer advocacy, cost containment goals, and excellent customer satisfaction for both internal and external customers. In his role, the Medical Advisor would embrace Cigna's vision, culture and values, representing Integrated Health Team mission in front of our customers, clients and other external and internal stakeholders.

He/she works with a multicultural population and is constantly aware of the cultural differences among that population and the geographical regions, combining health care global expertise with regional knowledge to better service our customers, partners and clients.

Ability to review, investigate, and respond to external and internal inquires/complaints. Provides guidance and acts as a mentor or coach for the nurses and other non-clinical staff.

Major Responsibilities And Desired Results

• Makes part of Integrated Heatlh Team, providing medical management services to customers worldwide
• Gives evidence-based advice on medical claims, taking into account internationally accepted protocols and local and/or regional customs and regulations.
• Supports, coaches, and monitors the Case Management Team and Care Team through our different Health and Clinical Case Management services and programs. Ensuring quality of performance, promoting optimal service delivery and accurate reporting. Gives advice on appropriate corrective action if necessary.
• Assist in the coordination of processes for improving quality of care and health outcomes for specifically delineated projects or populations.
• Assist and support the team's cost containment strategy, projects, and service delivery to meet our yearly affordability goals.
• Serves as a resource/educator regarding specific areas of expertise. Able to create and implement appropriate educational clinical programs content for internal and external audiences and link with Cigna University resources.

• Assists other functional areas:

• Underwriting Team, providing clinical advise on Underwriting processes and non-disclosure post-sale detection

• Payment Integrity Team:

• Providing clinical advice and recommending best practices to prevent and detect fraud, waste and abuse.

• Providing support to our Network Management Team.

• Health and Wellbeing Teams: Collaborating to develop, implement and deploy wellness solutions.

• Clinical Operations: Work together with the team on quality improvement and clinical management projects.
• Client Management and Client Support Teams
• Sales and Marketing Teams

• LPS team

• Makes part of the business continuity plan to ensure operational continuity to our customers

• Supports emergent/urgent out of office hours requests from Care Team and Case Management Team where MNR services are required.
• Other duties as assigned

Requirements

• Medical Doctor Degree with international healthcare experience
• 3-5 years of clinical experience preferable in a payer setting on medical management
• Experience in utilization management, case management, disease management, cost containment, insurance coverage and underwriting. Experience on disease management programs and tools is an advantage
• Experience in medical claims revision
• Strong interpersonal and communication skills
• Pro-active problem-solving and analytical skills.
• Ability to operate a personal computer, proficient with Microsoft office products, call center software, and a variety of software for medical management.
• Ability to work remotely, working from home
• Ability to build solid working relationships with staff, matrix partners, clients, customers and healthcare providers
• Stress resistant and efficient, finding a good balance between quality and quantity
• Ability to speak, write and read English and any other languages are an advantage

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.