Claims Associate Representative (GHB) - PSO- Cigna

Role Overview

This entry-level operations role helps keep partner claim data accurate and automated processing on track. Day to day, you will review recurring reports, make approved corrections in the policy administration system, and route exceptions to a supervisor or IT when they fall outside established procedures.

Key Responsibilities

• Prepare weekly reports, group items by error code, and update business-as-usual tracking records.
• Correct routine claim data, including member and partner identifiers, procedure and diagnosis codes, service dates, and billed or net amounts, using documented steps.
• Apply the prescribed action for each error type, resolving eligible cases and referring others for technical support.
• Escalate cases that require duplicate-closure handling, forced claim loading, invalid-data changes, or other adjustments beyond your authority; raise IT tickets as needed.
• Process adjustment and reconciliation reports by recording claim references, maintaining tracking sheets, and reprocessing or reversing claims according to procedure.
• Monitor the assigned mailbox and handle escalated cases within the applicable turnaround times.
• Add standard claim notes, keep logs complete, and file reports and supporting records in line with established procedures.
• Bring recurring issues and practical opportunities to improve data mapping, reporting, or workflows to your supervisor’s attention.

Requirements & Qualifications

• Diploma or degree required.
• English-language proficiency for written updates and communication with internal colleagues.
• Strong attention to detail and a consistent approach to data accuracy.
• Ability to follow step-by-step instructions and work within defined rules and approval limits.
• Comfort using multiple internal systems and Microsoft Office applications.
• Basic Excel capability, including sorting and filtering data, adding columns, and organising worksheets.
• Good organisation and workload management, particularly when completing recurring tasks and meeting turnaround times.
• Clear communication, sound judgement when identifying inconsistencies, and a willingness to flag system or data issues.
• Previous experience in administration, data entry, or shared services is helpful but not essential.