Claims Representative - Provider Services at Cigna

About the Role

The Claims Representative is responsible for accurate and timely processing of international medical claims from global providers, in line with contractual obligations, and standard operating procedures requirements. The role operates in a structured, high-volume environment and requires consistent judgement, disciplined process execution, and clear communication with internal stakeholders.

Responsibilities

• Process provider claims against policy and benefit rules, delivering decisions that meet quality and turnaround time standards.
• Validate and reconcile claim data across Administration, Workflow, and CRM platforms; ensure completeness, coding alignment, and internal consistency.
• Maintain full compliance with confidentiality, data protection, medical privacy, and audit documentation requirements.
• Identify and escalate claims issues in a concise context meeting both customer and provider satisfaction standards.
• Communicate relevant escalation updates to internal partners in a clear, structured, and timely manner.
• Monitor claim trends, anomalies, or workflow inefficiencies and communicate these to the Supervisor for action.
• Manage assigned claim queues proactively, maintaining throughput during routine and peak periods.
• Contribute to team cooperation, knowledge sharing, and a professional working environment.
• Execute any additional responsibilities assigned by the Supervisor.

Requirements

Education

• Bachelor’s degree in a Business, Mathematics, Economics, Statistics or related field.

Languages

• Proficiency in English required.
• Additional languages (French, Portuguese) are an added advantage.

Skills and Professional Attributes

• Strong decision making capability, with the ability to act based on available information.
•  Proficiency working with numerical data and structured information.
• Ability to navigate multiple systems and adapt quickly to new tools and processes.
• High attention to detail, with consistent accuracy across repetitive tasks.
• Reliable adherence to processes, documentation standards, and audit requirements.
• Ability to sustain quality and productivity expectations in a high volume environment.
• Strong teamwork orientation and willingness to support colleagues when needed.
• Demonstrate discretion when handling confidential medical information.