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Medical Claims Review Senior Analyst

Medical Claims Review Senior Analyst

Cigna

4 - 8 years

6 - 10 Lacs

Bengaluru

Posted:2 months ago| Platform:

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Skills Required

Medical Claims claims processing underwriting tpa health insurance insurance operations claim settlement

Work Mode

Work from Office

Job Type

Full Time

Job Description

Job Profile Summary Delivers specific delegated tasks assigned by a supervisor in the Medical Claims Review job family. Provides medical interpretation and decisions on identified health claims based on contractual benefits and medical circumstances and develops recommendations for resolution of questionable claims requiring further professional or committee review. Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials such as documentation provided by the physician or other supplier. Applies clinical knowledge to assess the medical necessity, level of services, and appropriateness of care in cases requiring prospective, concurrent, or retrospective utilization review. Completes day-to-day Medical Review tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. Requires an RN.

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Cigna

www.cigna.com

Hospitals and Health Care

Bloomfield CT

10001 Employees

489 Jobs

Key People

David Cordani

President and Chief Executive Officer
Eric Palmer

Executive Vice President and Chief Financial Officer
Sandeep Jauhar

Chief Medical Officer
Nicole Jones

Chief Human Resources Officer

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Medical Claims Review Senior Analyst

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