Cigna jobs, Insurance jobs, Customer Care jobs, Medical jobs, Healthcare jobs,
Nurse Case Manager – Portuguese or French Required
Major Responsibilities
- Manages an active caseload of case management cases for Cigna and provides one on one case management to customers to improve health status, reduce health risks and improve quality of life.
- Uses clinical knowledge and Cigna approved guidelines and tools to assess diagnosis and treatment plans and goals and identifies gaps in care or risks for readmission or complications.
- Works with a multicultural population and is constantly aware of the cultural differences among that population.
- Establishes patient centric goals and interventions to meet the member’s needs
- Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
- Delivers clinical programs including case management, chronic condition management, hospital support program, etc.
- Balances business needs with patient advocacy
- Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare.
- Visit providers to manage and coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians.
- Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved.
- Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
- Coordinate care with other nurses from other regions around the world when a need for local or regional expertise is important for better care or to comply with regulations
- Maintains accurate workflow and process documents
- Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.
- Serve as clinical liaison to Clients
- Other duties as assigned
Requirements
- Bachelor’s in nursing, 3-5 years of experience in international clinical management
- Experience in the Africa region & International market
- Fluent in English along with either Portuguese or French required
- Demonstrated organizational and leadership skills
- Strong interpersonal and communication skills
- Demonstrates problem-solving and analytical skills.
- Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements
- Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software.
- Experience with clinical guidelines solutions such as coverage policy and MCG guidelines
- Ability to build solid working relationships with staff, matrix partners, customers and providers
- Flexible to work on shifts/varying work schedules.
Customer Service Representative – Portuguese/Arabic/Chinese Required
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.
Key Areas
- Communication management in day-to-day queries of our clients and insurers through different channels (Email, Phone, Letter and Chat). The main communication channel will be Emails and Calls.
- As a Hybrid team, you require to manage customer interactions through Emails and Calls at the same time. You require to multitask between both channels based on Email and Call inflow and based on the requirements in the daily planning.
- Think about and contribute to using the most efficient communication channels (phone, e-mail, letter)
- Coordinate and ensure follow-ups of the assigned contracts/clients.
- Answering call from client and advising on the necessary information. To log call in the system and respond via email immediately over the call instead of assigning the task back to the queue.
- Follow up on personal queue for the cases where we received reply.
- Taking ownership on the emails assigned and to complete the necessary before end of business.
- Monitoring Queue to see if there is any queued call which require to be answered instead of allowing the call to drop or abandon.
- Check on medical reports submitted by client and see if we can approve Initial Letter of Guarantee to the provider.
- Check if the complete Reimbursement documents has been submitted before assigning case to Claims Team.
- Keep records and filing up to date.
- Pro-actively optimising the unit’s workflows to achieve set targets.
- Translate communications, medical reports or other documents if needed.
- Work according to the priorities indicated in the work plan and in order to keep under track the different KPIs (ASA, TAT, NPS, etc)
- Able to handle complaints and analyze them, identifying root causes that might lead to the improvement of customer satisfaction.
Qualifications
- Advance or bilingual knowledge of English is a must (C1/C2)
- Advance knowledge of one or more of these languages: Portuguese, Arabic, Chinese, German, French, Spanish (C1 Level).
- 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 is a plus.