PSO Claims Representative (APAC)

Location: Kuala Lumpur, Malaysia

Company

Cigna Healthcare, a division of hirify.global, supports customers in navigating the healthcare system and making informed decisions about their health.

What you will do

• Process and adjudicate provider claims, pre-approvals, reimbursements, and error adjustments according to benefit policies, claim manuals, and SOPs.
• Assess eligibility, medical necessity, policy coverage, and medical expenses while maintaining confidentiality.
• Handle recoupment and reconciliation activities, including communicating with providers and members by phone and email.
• Monitor high-cost claims, processing volumes, quality measures, service levels, KPIs, audits, and turnaround-time targets.
• Resolve complex queries with Finance, CSR, Eligibility, Network, Client Management, and other stakeholders.
• Maintain accurate system data, identify process improvements, and support the Team Leader and claims colleagues.

Requirements

• At least 1–2 years of experience in a similar role.
• Strong administration skills and proficiency with Microsoft Office applications.
• Excellent written and verbal communication skills, with the ability to communicate across a diverse population.
• Organized, analytical, adaptable, and able to work independently or as part of a team under tight deadlines.
• Broad awareness of medical terminology is advantageous; claims processing or insurance experience is preferred.
• Flexibility to work shifts and staggered weekends for overtime.

Culture & Benefits

• Collaborative work with cross-functional teams and matrix partners.
• Operational focus on accurate claims handling, fast transactions, productivity, and service quality.
• Opportunities to assist with colleague training and share knowledge.
• Work in an international healthcare and insurance environment.