MAJOR RESPONSIBILITIES

• 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 of Medical /Nursing specialization with international healthcare experience.
• 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 and growing enterprise.
• A dynamic, young and entrepreneurial company culture that values and stimulates initiative.
• Attractive salary conditions with extralegal benefits.