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IOH Provider Claims SME

IOH Provider Claims SME

CignaAlbemarle, NC, US
9 days ago
Job type
  • Full-time
Job description

SME Position

As an SME you will support Supervisor and Senior Supervisor in your relevant process.

Key to the role will be building / maintaining an in depth knowledge of (part of) the process to continuously improve the processes and share that knowledge to deliver a high quality customer centric service offering. Your role includes :

  • Building and maintaining a solid in depth knowledge in (part of) your process
  • Being an expert user of any of the used tools within the team and / or any of the partner set-ups in place
  • Being the organizational ambassador for your knowledge area within your own team and across the wider organization. You are the go to person in case of questions on your area of expertise.
  • In that role, being able to represent the Process / Organization in (enterprise wide) projects, stakeholder meetings, or act as a relationship manager towards some of our (internal / external) strategic partners or act as a trainer.
  • Being proactive in identifying improvement / enhancement opportunities and be active in seeking and sharing ideas for innovation in business processes.
  • Striving to provide excellent service to our Providers, Members and Clients
  • Playing an active role in a culture of continuous improvement
  • Review available documentation on knowledge management tool. Create new documents and amend existing ones according to business needs. Remove obsolete documentation.
  • Taking ownership of any escalated cases and providing updates to the Supervisor on any issues
  • Taking ownership of solving any issues (if applicable) in your area of expertise
  • Proactively addressing and / or escalating any risks
  • Developing / maintaining proactive / effective business relationships, internally, externally and with BPO partner to ensure a seamless delivery of service.
  • On-site training and support for new hires

Specific for IOH Provider Claims SME's :

  • Support the financial verification of the team, including approval of manual payments
  • Support of quality audits (financial verification + extra verification) with a clear focus on the financial and procedural accuracy company KPI's. You document your findings, share them with the supervisor and you discuss corrective actions on individual and team level with the Supervisor.
  • Responsible to provide training on specific topics where you act as a subject matter expert, be it a process or a client, including the lead of the training organization and coordination.
  • Lead the onboarding and training phase of newbies, or colleagues taking up new accounts, including their performance reporting.
  • Building and maintaining a solid escalation path for both in-house and BPO partner.
  • Support BPO partner for out of scope tasks and escalations.
  • Monitoring BPO team performance, such as Productivity, Quality results, PWB follow up and CRM tasks. Analyzing issues' root cause and propose / implement relevant actions to improve results with the support of Senior Supervisor.

    • Your profile :

  • Strong performance track record.
  • International mind-set, with holistic and able to work remotely with peers across locations.
  • 1 year of experience working at Cigna.
  • 2 years experience in a Claims role.
  • Claims IOH processes experience.
  • Fluency in English.
  • Good communication skills, and knowledge of Window tools, e.g. Excel, PowerPoint, Windows.
  • A growth mindset with a positive attitude towards change and the ability to play an active role in implementing change initiatives within your own process.
  • Action-orientated problem-solving attitude.
  • Able to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues.
  • Accountability assume ownership for achieving personal results and collective team goals.

    • Please include your CV and cover letter in the application.

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

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    Provider • Albemarle, NC, US