Medical Advisor at Cigna
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
Eligibility Representative- GHB at Cigna
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
Claims Representative – Africa Business at Cigna
We are looking for a detail-oriented claims Representative
to join our claims team. You will be responsible for 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 the 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:
- Diploma
or Degree Qualification.
- Knowledge
of Medical Terminologies, CPT codes and ICD-9 codes is an added advantage.
- 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.
Data Management Strategy and Governance Manager at Cigna
Job Title: Data Quality & Governance Lead
Location: Madrid, Nairobi, or Bengaluru
Job Type: Full-Time
About the Role: We are seeking a highly skilled and
experienced hands-on lead to join our team. The ideal candidate will be
responsible for leading the definition, development and implementation of data
governance initiatives and implementing a global DQ (Data Quality) framework
that enhances trust in data across the enterprise . This role requires a deep
understanding of data governance and data quality concepts, strong delivery
focus, and the ability to manage and mentor a team. This role will report
to the Data Strategy & Governance Lead, within our Data & Analytics
function.
Key Responsibilities:
- Lead
the design, development, and implementation of updated data governance
frameworks, policies, and procedures.
- Design
and implement a global data quality strategy aligned with enterprise data
governance and regulatory requirements.
- Develop
and operationalize a data quality framework, including standards, metrics,
and controls, with automation at its core. Develop a data quality
improvement roadmap, that sets data quality targets and lead delivery in
meeting the agreed targets.
- Manage
a team, providing guidance, mentorship, and support to ensure high
performance and professional growth.
- Collaborate
with cross-functional teams, data owners, stewards, engineering, and
analytics teams to embed DQ practices into data pipelines and business
processes. Oversee the delivery of data governance products and solutions
to production, ensuring they meet quality, performance, regulatory, and
security standards.
- Support
regulatory compliance efforts by ensuring data quality processes meet
regional and global standards.
- Establish
monitoring and reporting mechanisms to track data governance initiatives,
identifying areas data quality KPIs and drive continuous improvement.
Focus on metadata management, data quality, and the use of AI-based tools
to enhance data governance practices.
- Implement
strategies to make data more available and accessible across the
organization while ensuring robust audit and control mechanisms are in
place.
- Stay
up-to-date with industry trends and advancements in data governance and
related technologies, incorporating relevant innovations into the
organization’s practices.
- Maintain
a strong delivery focus, ensuring that projects are completed on time and
within scope, with clear milestones and timelines.
- Build
and maintain strong business partner relationships to align data
governance initiatives with business needs and priorities.
- Develop
and deliver training programs to enhance data literacy and embed
governance practices across the organization.
- Act as
a trusted advisor to senior stakeholders on data quality risks and
opportunities.
Qualifications:
- Bachelor’s
degree in Computer Science, Information Technology, or a related field;
advanced degree preferred.
- Proven
experience in data governance, data quality and management, or a related
field, with a strong understanding of data governance and quality concepts
and best practices.
- Hands-on
experience with Collibra and AWS data services (e.g., S3, Glue, Redshift).
with experience in delivering data governance products to
production.
- Experience
integrating data quality processes into BI/reporting tools such as
QlikSense.
- Familiarity
with data quality automation and scalable data validation
techniques.
- Demonstrated
experience in managing and leading engineering teams, with a focus on
fostering collaboration and innovation.
- Excellent
problem-solving skills and the ability to think strategically about data
governance challenges and solutions.
- Strong
communication and interpersonal skills, with the ability to effectively
convey complex technical concepts to non-technical stakeholders.
- Experience
with data governance tools and technologies, such as data catalogs,
metadata management, and data quality solutions (e.g. Collibra).
- Knowledge
of regulatory requirements and industry standards related to data
governance and data protection (e.g., GDPR, NBB, CCPA).
Preferred Skills:
- Certification
in data governance or data management (e.g., CDMP, DAMA).
- Experience
working in regulated industries (e.g., financial services,
healthcare).
- Knowledge
of data mesh or federated data governance models.
- Experience
with cloud-based data platforms and services (e.g., AWS, Azure, Google
Cloud).
- Familiarity
with data privacy and security best practices.
- Experience
with AI-based tools and technologies to enhance data governance and data
quality.
Why Join Us:
- Opportunity
to lead and shape the data governance and quality strategy of a dynamic
and innovative organization.
- Collaborative
and inclusive work environment that values diversity and professional
growth.
- Delivery-focused
and mission-oriented role with a strong emphasis on engineering and
collaboration.
- Located
within the Data & Analytics Organization, with a focus on revising
data governance and data risk frameworks.
- Clear
focus on delivering projects on time and within scope, with established
timelines and milestones to track progress and ensure successful
delivery.
- Build
and maintain strong business partner relationships to ensure alignment
with business needs.
- Develop
and deliver training programs to enhance data literacy and governance
practices across the organization.
Technical Customer Support Analyst at Cigna
About the job
Cigna, a leading global health insurer, is experiencing an
exciting period. We are looking to recruit an experienced IT Service Analyst in
Nairobi. The successful candidate will be a member of the Technology,
Engineering, and Operations group.
Reporting to the Service Desk Team leader, you will provide
operational support and account administration to the Service Desk team.
The successful candidate will be a high-performing
individual who is methodical, inquisitive, and passionate about technology and
service.
You will work about 66% from the Cigna office and 34% from
home.
Main duties and responsibilities
- Provide
technical support to onsite and remote users.
- Install,
configure and support (IMAC) end-user devices.
- Manage/monitor
IT Service Desk Incidents and Service Request via the call management
system.
- Manage
User system access for various applications.
- Identify
ways to improve the quality of the service provided and/or the efficiency
of the processes within the team.
- Ensure
all incidents are managed following targets set out in SLA.
- Escalate
any issues/ outages to the IT End User Services Team leader.
- Prioritising
and allocating all requests within IT Support teams.
- Working
every 3 weeks on Saturday from 8 AM until 1 PM (from home).
- Working
every 7 weeks (Mon-Fri) from 4 PM until midnight (from home).
Required Skills
- Two
years of experience within an IT support team
- Incident
management skills
- Experience
with a call management system
- Experience
with Microsoft Office
- Windows
11 support and build experience. ( both OS and pc hardware)
- Active
Directory
- Citrix
Support
- SCCM
- Exchange
account maintenance
- Networking
& patching
Desirable Skills
- ITIL
Foundation certified.
- Microsoft
certification.
- Experience
with Service Now.
- Avaya
Telephony
About You
- Communicate
clearly and effectively.
- Excellent
communication skills and be able to correspond efficiently and
effectively. This includes both verbal and written formats.
- A
positive ‘can-do’ attitude with a strong commitment to customer support.
Receptionist Vacancy
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.
YOUR PROFILE
- Bachelor’s
degree in relevant field, prior front office /customer service experience
preferred. Minimum 3 years work experience. Excellent
communicator both oral and written.
- Organizational
skills: you can assess different tasks and proceed according to
priorities; you are able to plan ahead in order to ensure daily workflows
are respected, you are able to work in close cooperation with your
colleagues You can rapidly and accurately handle a large quantity of
documents You can keep a clear overview of the work to be done, even
in busy times.
- Strong
energy and drive to work across cultures and time zones
- You
can deal with (confidential) information with the utmost discretion.
- You
can perform accurate data entry.