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Quality Review and Audit Analyst

As a Quality Review & Audit Analyst working on the Payment Integrity Team you will be directly supporting Cigna’s affordability commitment within Cigna International’s business.

Your responsibilities will include:

  • Identifying and preventing fraudulent, wasteful and abusive expenses from around the globe
  • Perform a variety of prepay focused cost avoidance activities including:
    • Identifying suspicious activity and submission to the designated FWA and SIU team for investigation
    • Identifying internal operational errors to prevent incorrect payment being made
    • Electronic outreaches to providers requesting documents and confirming information
    • Occasional telephonic outreach to providers in local region to negotiate savings
    • Verification of charges and services
    • Negotiation on high cost provider claims
    • Partner with cost containment teams in other geographies to share best practices
    • Analyze data on prior payments to identify additional opportunities
    • Participate in projects to improve business processes
  • Working collaboratively in a team environment to efficiently utilize each individual’s strengths
  • Working closely with other departments to ensure our activities do not have an unnecessary negative impact on our customers
  • Providing feedback to other departments in order to put in place safeguards to prevent further risk exposure

Qualifications

  • Demonstrated strong organization skills
  • Strong attention to detail
  • Ability to quickly learn new and complex tasks and concepts
  • Competent in processing or investigating claims on either the Mainframe or Diamond claim platforms
  • Fluency in foreign languages in addition to fluent English is a strong plus
  • Data analysis and reporting skills preferred
  • Inquisitive nature capable of thinking critically and challenging assumptions
  • Demonstrated follow through on complex problems and tasks
  • Comfortable working independently and with a team
  • Ability to balance multiple priorities at once and deliver on tight timelines
  • Ability to stay up to date on operations workflows
  • Ability to develop and effectively communicate presentations and training materials
  • Strong written and verbal communication skills
  • Patience and creativity amongst your strong points
  • Proficiency with Microsoft Excel needed. Word, PowerPoint, Outlook, and SharePoint preferred
  • Experience processing international claims preferred
  • Comfort with telephonic outreaches to global entities preferred

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Competencies

  • Learning and applying quickly
  • Organizing
  • Priority Setting
  • Problem Solving
  • Interpersonal Savvy

Senior Client Executive

Based in Nairobi, you will be part of the Client Management Team EGS (IO/NGO) and will be involved in a wide range of day to day inward and outbound interactions with the IO/NGO client base, thus ensuring optimal service and high levels of satisfaction. Your main areas of responsibility will be:

  • Supporting tasks for the overall client portfolio.  

Respond to day-to-day (internal and external) questions, coordinate solutions for escalations, gather benchmark information, identify optimizations, advise internal teams on client specific issues, participate in relevant internal meetings, prepare external meetings, provide or assist in reporting etc.

  • Independently manage a selection of SME client accounts.

Focal point for client contacts, relationship management, renewal negotiations, contract management, analysis, etc.

  • Involvement in key processes
  • Be involved in key processes like implementation of plans, RFP’s and Reporting.
  • In your role you build up a relationship of trust with the contact persons of the clients you are servicing and you are the contact person for these clients for our own internal departments.  
  • You work in a full-time regime.
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YOUR PROFILE

  • You have a master degree or equivalent by experience
  • You have 2-5 years of experience in the insurance or administration industry
  • You have excellent knowledge of English.
  • You have excellent communication skills, written and verbal
  • You are sociable: correct, professional and at ease in contact with different stakeholders (individual insured, contact persons of the organisations, colleagues and persons in charge).
  • You are a team player.
  • You are looking for a professional experience in an international context, where you can fully use your skills;
  • Working under pressure is not an obstacle and you are not afraid to take ownership of a situation
  • You are always looking for solutions.
  • You are capable of prioritizing workloads in order to meet tight deadlines
  • You have some experience in collation of data and statistical analysis
  • A sound knowledge of Excel and Word are required. Experience with Access is a plus-point

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