IOH Member Claims Representative - Cigna Healthcare

About Cigna Healthcare Cigna Healthcare is a global health service company dedicated to transforming healthcare. With roots in the U.S. and operations in over 30 countries, we serve more than 180 million customers and patients worldwide. Ranked 13th on the Fortune 500 in 2025, Cigna is recognized as one of the most trusted and influential names in the industry. Our mission is to improve the health, well-being, and peace of mind of those we serve. You will join a globally recognized organization where trust, clear communication and a positive culture shape how we work. Our leaders are consistent, approachable and supportive, helping you maintain balance while doing meaningful work. We look for people who thrive in collaborative environments, care about meaningful change and want to grow in a company that puts people first. At Cigna Healthcare, your work contributes to better care experiences and supports customers through important moments in their lives. YOUR JOB • As Claims Representative you analyze claims in respect of client medical costs. • You adjudicate medical/dental and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. • You analyze reimbursements according to the contract agreements and assess, code and calculate them using a computerized claims processing system. • You pass communications to the communication team to solve or preempt any possible issues with your stakeholders. • Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your supervisor when this is not achievable. • You take responsibility/ownership of complex cases. You handle them accurately and with the personal attention that is required. • You keep your knowledge up to date with respect to the medical information necessary for handling claims and you take part in trainings to ensure you are up to date with policies, processes and other required information. • You are attentive to inaccuracies in the files and communicate them to your team leader/departmental head. • Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first call resolution where possible. • Carry out other adhoc tasks as required in meeting business needs. YOUR PROFILE • Diploma or degree in a relevant field. • Previous experience handling medical claims within a health insurance or healthcare provider environmen t is an added advantage. • Strong working knowledge of English, with confidence communicating with both internal and external stakeholders. • French language proficiency is an added advantage. • Previous experience in an analytical role with strong numerical ability with a high level of accuracy and attention to detail is desirable. • Good analytical and problem-solving skills, with the ability to review information and make sound decisions. • Customer-focused mindset, with the ability to balance accuracy, service and operational requirements. • Ability to work independently, take ownership of tasks and escalate appropriately when required. • Ability to adapt quickly to changing processes, priorities and systems. • High level of integrity and discretion when handling confidential and sensitive medical or customer information. • Proactive and collaborative approach, with a willingness to share knowledge and best practices with colleagues. • Comfortable learning and working with computer-based applications and claims processing systems. About Cigna Healthcare 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 wi