From the employer's hiring system · Verified employer
IOH Member Claims Representative
Cigna Healthcare
Job at a glance
- Employer
- Cigna Healthcare
- Position
- IOH Member Claims Representative
- Location
- Kenya One Africa Place
- Job type
- Full-time
- Education
- Diploma or degree in a relevant field
- Salary
- Not stated in the advert
- Application deadline
- 29 October 2026
- Posted on VacancyKE
- 22 October 2026
VacancyKE summary
Cigna Healthcare is hiring an IOH Member Claims Representative in Nairobi to adjudicate medical, dental and vision claims. You will analyse reimbursements, manage complex cases and ensure timely settlement while maintaining high accuracy.
What stands out about this opportunity
- Role involves adjudicating medical, dental and vision claims.
- Based at One Africa Place, Nairobi.
- French proficiency and prior claims experience are advantages.
Key responsibilities
- Analyse client medical costs and adjudicate medical, dental and vision claims per policy terms.
- Assess, code and calculate reimbursements using computerised claims processing systems.
- Monitor turnaround times and highlight delays to supervisors when targets are not met.
- Take ownership of complex cases, handling them with personal attention and accuracy.
- Respond to enquiries on plan design, eligibility and claims status within set timeframes.
- Communicate potential stakeholder issues to the communication team to resolve or preempt problems.
- Identify inaccuracies in files and report them to your team leader immediately.
- Update knowledge on medical information and participate in training on policies and processes.
Who should apply?
This role suits candidates with a diploma or degree who possess strong analytical skills, English fluency and the ability to handle confidential medical data accurately.
Key requirements
- Diploma or degree in relevant field
- Strong English communication skills
- Analytical and problem-solving abilities
- Integrity with confidential data
- Computer literacy for claims systems
Nice to have
- Previous experience handling medical claims in health insurance or healthcare.
- French language proficiency.
- Experience in an analytical role with strong numerical ability and attention to detail.
How to apply
- Apply via the Cigna Careers portal link provided in the advert.
- Email [email protected] only if you require reasonable accommodation.
Official source: From the employer's hiring system · cigna.wd5.myworkdayjobs.com. VacancyKE never charges job seekers.
Original employer advertisement
Published by Cigna Healthcare on cigna.wd5.myworkdayjobs.com. Shown for reference; the employer’s version is the official one.
The employer’s advert
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 with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.
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 with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.