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Medical Claims Review Senior Analyst

The Cigna Group

3 years

upto 5 LPA

Bengaluru

5 Feb. 27, 2025

Job Description

Job Type: Full Time Education: B.Sc Nursing/MSc. Nursing/Lifesciences graduates/B.Pharm/M.Pharm Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Medical Claims Review Senior Analyst

📍 Location: Bengaluru, Karnataka, India
📂 Category: Medical & Pharmacy
📌 Job ID: 25002301
📅 Posted Date: February 25, 2025
👩‍⚕️ Eligibility: Open to experienced professionals with a Nursing background (Freshers not eligible)

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is dedicated to advocating for better health at every stage of life. We guide customers through the healthcare system, providing them with insights and support to make informed decisions about their well-being. Join us in our mission to improve healthcare accessibility, cost management, and patient care.

Role Overview

The Medical Claims Review Senior Analyst (Nurse Clinical Advisor) plays a crucial role in ensuring cost-effective, high-quality care for customers worldwide. This position involves evaluating medical records and claims, providing clinical guidance, and collaborating with healthcare providers to optimize medical resource utilization.

Key Responsibilities

✔ Medical Record Review & Claim Evaluation

Assess and evaluate medical records and insurance claims to determine the appropriate level of care.
Review treatment plans and ensure alignment with medical guidelines and cost-containment objectives.
Assist in fraud detection by identifying discrepancies in claims and medical records.

✔ Clinical Advisory & Support

Provide clinical guidance and support to clients, healthcare providers, and insurance staff.
Monitor clients' medical conditions and progress, making recommendations for adjustments in care plans when necessary.
Ensure customers receive evidence-based medical management services.

✔ Collaboration & Communication

Work closely with Customer Service, Care Teams, Nurse Case Managers, and Medical Advisors to streamline healthcare services.
Collaborate with healthcare providers to assess length of stay management and resource utilization.
Educate and train insurance staff on medical conditions, treatment options, and best clinical practices.

✔ Policy Compliance & Cost Containment

Ensure patient care aligns with company policies, procedures, and regulatory guidelines.
Contribute to cost containment projects and service delivery enhancements.
Stay updated with medical advancements and industry trends for better decision-making.

Eligibility Criteria

👩‍⚕️ Who Can Apply?
❌ Freshers are NOT eligible for this role.
✔ Required Experience: Minimum 3 years of experience in nursing, clinical advisory, or case management.
✔ Education: Bachelor’s degree in Nursing (B.Sc Nursing or equivalent).
✔ License Requirement: Active nursing license in good standing.

Required Skills & Competencies

✅ Strong knowledge of medical terminology and clinical procedures.
✅ Excellent analytical and decision-making skills for medical claims assessment.
✅ Effective communication and interpersonal skills for collaboration with healthcare providers and insurance teams.
✅ Fluency in English (reading, writing, speaking); additional languages (Spanish, French, Arabic, German, or Italian) are desirable.
✅ Ability to handle sensitive and confidential information with discretion.

Why Join Cigna Healthcare?

✔ Work with a global leader in healthcare services.
✔ Contribute to improving patient care and optimizing healthcare costs.
✔ Competitive salary, benefits, and career growth opportunities.
✔ Be part of a collaborative and impact-driven team.

Equal Opportunity Employer Statement

Cigna Healthcare is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities without discrimination based on race, religion, gender, nationality, disability, or any other legally protected status.

📩 Application & Contact Information:
Interested candidates are encouraged to apply through Cigna Healthcare’s official career portal.

📌 Take the next step in your healthcare career – Apply today!

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Medical Claims Review Senior Analyst

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