Claims Associate Analyst

About the role

Cigna's Claims Associate Analyst serves providers and insurance companies by determining their requirements, answering inquiries, resolving problems and fulfilling requests. The role maintains accurate medical coverage details, keeps pre-approvals and claims processing and adjudication running smoothly within NHS software systems, and follows the organization's terms and policies as well as regulations from authorities such as MOH and DHA.

Key responsibilities

• Issue online and verbal authorizations based on member coverage and medical justification.
• Assist providers and payers with queries by phone or email, and maintain authorization and report files.
• Process claims according to policy coverage and medical necessity, and enter and adjudicate claims in the NHS system.
• Maintain the claims processing and adjudication cycle and ensure adherence to predefined turnaround times for claims and pre-approvals.
• Monitor qualitative and quantitative claims measures and achieve the processing targets set by the team leader.
• Help train colleagues, share knowledge and implement new formats, training and processing rules.
• Ensure timely completion of team tasks and take initiatives to improve team efficiency.

Required profile

• University degree in a medical or para-medical discipline from a reputable university.
• 1-2 years of healthcare or hospital experience (e.g., surgery, ICU or GP).
• 1-2 years of insurance industry experience is preferable but not mandatory.
• Excellent oral and written communication and English; Arabic is a definite plus.
• Team player with customer service orientation, discretion with confidential information, and ability to work under pressure and meet tight deadlines.

Required skills

• Computer literacy.
• Ability to assess eligibility under UAE (HAAD and DHA) guidelines and policy boundaries.