Medical Claims Review Senior Analyst

Job Description

Job Description- Medical Advisor The Medical Advisor is a member of the medical team which 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, cost containment goals, and excellent customer satisfaction for both internal and external customers. 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. He/she works with a multicultural population and is constantly aware of the cultural differences among that population and the geographical regions. Major responsibilities and desired results: Part of a clinical team that provides evidence based medical management services to customers worldwide Give evidence-based advice on medical claims, taking into account compliance, internationally accepted protocols and local and/or regional customs and regulations. Support and monitor the case management, disease management and other clinical services and assure quality of performance against QA standards to promote optimal service delivery and ensure accurate statistical data and reports. Give advice on appropriate corrective action if necessary. Assist in fraud detection. Assist is the coordination of processes for improving quality of care and health outcomes for specifically delineated projects or populations. Excellent communication and facilitation skills are keys to success. Assist and support the team in cost containment, assist in projects and service delivery to meet goals. Work together with the team on quality improvement and clinical management projects within Clinical Operations 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. Other duties as assigned. Location: India Languages: English, fluent and any additional language will be considered. Experience: Medical Degree 3+ years of experience in insurance sector would be an asset.