Medical Claims Review Senior Analyst/Medical Advisor - Bengaluru / Bangalore - Cigna Medical Group

    Cigna Medical Group
    Cigna Medical Group Bengaluru / Bangalore

    4 days ago

    Full time
    Description

    Responsibilities:

    • Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met
    • Evaluate itemized bills against reimbursement policies
    • Adheres to quality assurance standards
    • Serves as a resource to facilitate understanding of products
    • Handles some escalated cases; secures supervisory assistance with problem solving and decision making
    • Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals
    • Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally
    • Analyze clinical information
    • Perform claim reviews with focus on coding and billing errors
    • Identify and refer cases for possible fraud/abuse or questionable billing practices to the appropriate matrix partners
    • Handle multiple products and benefit plans
    • Works under moderate direct supervision

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