Vacancies 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.

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Cigna provides health insurance services around the world. We’re passionate about helping people improve their health, well-being, and sense of security. We started over 200 years ago and we have continued to innovate and expand our territories and services ever since. At Cigna Africa, we focus on the unique needs of clients and their members living and working in every country across the African continent.

What are your main responsibilities?

• You are responsible for the client communication for designated account relationships and Contracts.
• You are required to response to the client on timely manner providing full and accurate information in one go.
• Handle calls and e-mails and respond to simple and complex inquiries regarding eligibility, cards status, envoy registration/navigation, policy benefits, issue certificates of insurance, claims status and other related information and provide solutions for customers and clients.
• Receives requests by mail, telephone, or in person regarding insurance claims/policies. Responds to inquiries from policy holders, clients, brokers and/or others.
• Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
• Mails or routes claim forms and supporting documentation to various units for final processing.
• Excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints, or appeals ranging from routine to moderate complexity.
• May seek assistance with complex customer services issues.

Qualifications

• Must have a diploma or bachelor’s degree certificate
• Excellent English written and oral communication skills
• Portuguese written and oral skill is a must
• Exceptional organizational and time-management focus
• Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
• 1+ years of customer service experience analyzing and solving customer problems required; call center experience a plus
• Ability to perform in a high volume, fast paced call center environment
• Proven ability to work independently as well as a productive member of a team
• Intermediate proficiency in Microsoft office suite; high level capacity to multitask independently and on a computer
• Knowledge of medical terminology a plus

Conditions/requirements

• Work in 24 x 7 rotation shifts.
• 5 days a week.
• In split shifts (some hours in the morning and remaining hours in the afternoon or evening) and public holidays

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YOUR JOB

• You are a member of the Integrated Health Team, servicing the International Organisations. More specifically you’ll take part in the CARE team, a team of non-clinically trained staff, and close work together with the CARE teams worldwide (Antwerp – Madrid – Kuala Lumpur – Singapore - Greenock – Nairobi)
• You are responsible for the timely sending of all Guarantees of Payments together with your colleagues. The Guarantee of Payment is a confirmation towards the hospital regarding length of admission, treatment and insured amount. To be able to provide this confirmation, the following steps are necessary:
• You analyse requests for medical treatments and hospitalizations. You verify the patient’s extent of cover, our relationship with the provider, the need for medical review and the costs. You monitor the file from an administrative perspective and work in close cooperation with the Care Coordinators and Case Managers.
• You have frequent contacts with medical providers and individual insured, mainly by phone, to obtain all necessary information.
• You are the focal point of contact for hospitals regarding all their questions related to the Guarantee of Payment.
• All our clients and medical providers are internationally located. Therefore you manage the English language well, both spoken and written.
• Translate and interpret medical and other relevant documents for case analysis
• Work independently and effectively to communicate to internal and external customers by telephone and e-mail.
• Maintain accurate workflow and process documentation following outlined processes.
• You are flexible to work during the night, with working hours from 03:00 PM to 01:00 AM (Kenya time) for 5 days a week.
• You will also be flexible to work on Saturdays and Sundays on a rotational basis with other team members.

YOUR PROFILE

• You are fluent in English, both spoken and in writing. Knowledge of other languages (French, Portuguese, Spanish, German) is a key requirement.
• You are flexible to work during night/day shift and over the weekend on rotational basis.
• You are customer-focused: work efficiently with internal partners to find best solutions for customers.
• You are disciplined: follow procedures, agreements and document flows correctly.
• You are computer-literate: quick to learn International in-house systems and use current office applications.
• You have an analytical mind.
• You work in an accurate and independent way.
• You can work against deadlines.
• You are stress resistant.
• You are a team player.
• Work experience in a medical environment is a plus, though not required.