上海招聘

Major responsibilities and desired results:

• Part of a clinical team that provides medical management services to customers worldwide but mainly Great China, Singapore, but also some other countries in APAC as well.
• Give evidence-based advice on medical claims, taking into account internationally accepted protocols and local and/or regional customs and regulations.
• Support and monitor the case management, disease management and other clinical services and assure quality of performance against QA standards to promote optimal service delivery and ensure accurate statistical data and reports.  Give advice on appropriate corrective action if necessary.
• Assist in fraud detection.
• Assist in the coordination of processes for improving quality of care and health outcomes for specifically delineated projects or populations. Excellent communication and facilitation skills are keys to success.
• Execute cost containment strategy, assist in projects and service delivery to meet goals.
• Communicate with providers and doctors so as to conduct medical review efficiently
• Customers/ brokers education or communication based on case needs
• Support global business with local medical knowledge.
• Track the day to day case volume and work with team leader, analyse the data on regular basis upon needs.
• Other duties as assigned

Requirements:

• Nurse background with international healthcare experience specially in China, experience in other APAC countries is an advantage
• 3-5 years of clinical experience preferable in a payer setting on medical management
• Experience in utilization management, case management, and disease management programs and tools is an advantage
• Strong interpersonal and communication skills
• Demonstrates pro-active problem-solving and analytical skills.
• Knowledge of utilization/case management, cost containment services, managed care, insurance coverage, and financial management
• Ability to operate a personal computer, proficient with Microsoft office products, call center software, and a variety of software for medical management.
• Ability to build solid working relationships with staff, matrix partners, clients, customers and healthcare providers
• Stress resistant and efficient, finding a good balance between quality and quantity
• Fluency in Mandarin and English, Cantonese or other foreign language would be the advantage

Cigna is a global health services company dedicated to helping people improve their health, well-being and sense of security. Over 40,000 employees serve 95 million customers in many places around the globe and support our wide-range of international health insurance plans to help meet the needs of individuals, families and businesses.
 
Now the Cigna China Center needs you. You are welcome to join us.