The incumbent will involve in the daily operations of both individual and group medical claims teams. He / She will also work with external service providers to deliver the best quality claims service to our policyholders, members, brokers and business partners.

Job Responsibilities:

Claims Operations & Management

• Perform various claim administrations processes effectively and efficiently while striking a balance between compliant to claims guideline and customer centricity.

• Adjudicate referred medical claims under different distribution channels.

• Review referred complaints. Oversee the mitigation of weakness to improve the extent of customer centricity.

Vendor Co-operations & Management

• Control the performance of external vendors closely to meet the agreed service levels and KPI.

• Oversee the Network / Third Party Administrators (TPA) to deliver the required claims service to both our internal and external customers.

• Involve in audit review of claims processing by external vendors to identify improvement areas and ensure adherence to standards and guidelines set by the company and regulations.

Stakeholder Management

• Build and maintain strong relationship with external vendors, clients and internal front-end and back-end teams by providing training or presentation on the company’s claims services.

• Work closely with internal IT and external IT vendors to manage the end-to-end process of system enhancement including full cycle user requirement gathering and UAT.

Data Analytics

• Monitor compiled management report and ad-hoc report for claims management.

Job Requirements:

• Degree holder, preferably with insurance-related qualifications, e.g., LOMA, FLMI, ICA.

• At least 5 years’ experience in medical claims adjudication / administration

• Solid technical skills in individual and group medical claims.

• Experience in working or managing the Network / Third Party Administrators (TPA).

• Proven track record of working with IT, vendors and stakeholders on product development, developing user requirements and test cases for system, and conducting UAT.

• Proficiency in Microsoft Excel with analytical mindset.

• Frequent user of Microsoft PowerPoint. Confident to present ideas visually and verbally.

• Good team player, able to work independently and under pressure in a fast-paced environment.

• Possess strong customer centricity mindset.

• Excellent interpersonal, communication and influencing skills.

• Cantonese speaker with good command of both English and Chinese.

• Candidate with less experience will be considered at Senior Officer level.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.