The job profile for this position is Medical Claims Review Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.
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Medical Claims Review Senior Analyst/Clinical supervisor – Complex Claim Unit
Provides clinical review expertise for high dollar and complex claims, including facility and professional bills. Provides cost containment services by identifying coding and billing errors and insuring application of Medical and Reimbursement Policies. Additionally identifies cases for potential fraud and abuse and makes referrals.
Major Job Responsibilities
Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met




Evaluate itemized bills against reimbursement policies
Adheres to quality assurance standards
Serves as a resource to facilitate understanding of products
Handles some escalated cases; secures supervisory assistance with problem solving and decision making
Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals
Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally
Performs additional unit duties below as appropriate:
Participate on special projects.
Perform random or focused reviews as required.
Support and assist with training and precepting as required
Analyze clinical information
Perform claim reviews with focus on coding and billing errors
Identify and refer cases for possible fraud/abuse or questionable billing practices to the appropriate matrix partners
Handle multiple products and benefit plans
Works under mo

📌 Medical Claims Review Senior Analyst (India)
🏢 The Cigna Group
📍 India