Medical Claims Review Analyst - Bengaluru

Only for registered members Bengaluru, India

5 days ago

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Job summary

The Medical Advisor is a member of the medical team which develops and manages health and wellness programs for Cigna customers.


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/li>Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals(li>Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally/li>
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