This role provides functional expertise on cases ensuring that medical decisions adhere to Cigna’s global clinical guidelines. He/she will manage pre-authorization and claims review services to ensure cost-effectiveness and appropriateness of treatment, with the goals of generating cost savings and improving health outcomes. The Medical Consultant will also partner with other business divisions such as Sales and Client Management, by applying medical knowledge to support the business needs.
Job Responsibilities:
Manage the pre-authorisation process for cases in Hong Kong, assessing proposed treatment and therapies for medical necessity, in accordance with global medical guidelines.
Review claims and evaluate the appropriateness and cost-effectiveness of the medical treatment and services.
Act as a clinical liaison and advisor for other business divisions.
Engage and develop relations with key healthcare providers locally to improve customer experience and optimise cost containment efforts.
Prepare and deliver training to non-clinical associates, serve as resource to provide ongoing education to other business units within the Company.
Ability to work in ambiguous or new situations by demonstrating a structured approach to diagnosing the problem, analyzing alternatives, recommending and implementing best solutions.
Job Requirements:
Bachelor of Medicine, Bachelor of Surgery (MBBS) degree or equivalent
Minimum 5 years’ clinical experience and completed rotations in the following areas: Family Medicine, including Preventive Health; General Surgery; General Medicine; Orthopedics; Obstetrics and Gynaecology
Prior experience in health insurance industry is a bonus but not required
Familiar with the healthcare system in Hong Kong
Fluent in English and Chinese and/or Cantonese – written and spoken
Strong analytical capabilities with a focus on outcomes and results
Ability to work independently
Comfortable with working with all levels of management
Culturally sensitive to a diverse, international workforce
About The Cigna Group
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.
The Cigna Group is a global health company committed to creating a better future built on the vitality of every individual and every community. We relentlessly challenge ourselves to partner and innovate solutions for better health.
The Cigna Group includes products and services marketed under Cigna Healthcare, Evernorth Health Services or its subsidiaries. The Cigna Group maintains sales capabilities in more than 30 countries and jurisdictions, and has more than 190 million customer relationships around the world.
