International Health Claims Representative
Location: Bengaluru, India
Function: Healthcare Operations – Claims
Employment Type: Full‑Time
Shift: US / EMEA shifts (rotational as required)
Role Summary
The International Health Claims Representative is responsible for end‑to‑end processing of medical insurance claims for global health plans. The role ensures accurate adjudication, compliance with international healthcare policies, and adherence to service level agreements (SLAs) while delivering high‑quality outcomes for members, providers, and clients.
Key Responsibilities
Claims Processing & Adjudication
- Process international health insurance claims (inpatient, outpatient, dental, vision, pharmacy as applicable)
- Review claims for eligibility, coverage, coding accuracy, and policy compliance
- Apply benefit plans, exclusions, deductibles, co‑pays, and limits accurately
- Ensure first‑pass yield (FPY) and productivity targets are consistently met
Compliance & Quality
- Adhere to client‑specific SOPs, global healthcare regulations, and data privacy standards
- Identify discrepancies, escalate complex cases, and follow established resolution workflows
- Support internal and external audits with accurate documentation
Stakeholder Coordination
- Work closely with providers, members, and internal teams to resolve claim queries
- Respond to inquiries via system notes, emails, or case tools within defined TATs
- Collaborate with QA and SMEs to drive quality improvement
Continuous Improvement
- Identify claim trends, repeat errors, and improvement opportunities
- Participate in process updates, refresher training, and transition activities
- Maintain up‑to‑date knowledge of policy and system changes
Key Skills & Competencies
Technical Skills
- Strong knowledge of international health insurance claims processing
- Understanding of:
- Medical terminology
- ICD / CPT / HCPCS coding (as applicable)
- Benefit plans and policy interpretation
- Experience working with claims adjudication systems and workflow tools
Behavioural & Professional Skills
- High attention to detail and analytical thinking
- Strong written and verbal communication skills
- Ability to manage volume with accuracy in a fast‑paced environment
- Customer‑centric mindset with problem‑solving orientation
Education & Experience
- Graduate in any discipline (Healthcare / Life Sciences preferred)
- 2–4 years of experience in:
- International Health Insurance Claims
- Global Healthcare BPO operations
- Exposure to US / EMEA healthcare clients is an advantage
Performance Metrics
- Productivity & throughput
- Quality & audit scores
- SLA / TAT adherence
- Error rate and rework reduction
- Attendance & schedule adherence
Preferred Attributes
- Willingness to work in global shifts
- Experience in large‑scale healthcare operations
- Prior exposure to transitions or new client onboarding
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.