وصف الوظيفة
Role Overview
Account Installation Representative at Cigna Healthcare, based in Saudi Arabia. This role is responsible for accurately configuring and maintaining medical benefit plans within internal and third-party administrator (TPA) systems to ensure members, providers, and clients have correct and up-to-date information on eligibility, coverage rules, authorization requirements, and claim adjudication parameters.
Company Overview
Cigna Healthcare is a global health service company with roots in the U.S. and operations in over 30 countries, serving 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. Cigna Saudi Arabia, a branch of Cigna Worldwide Insurance Company, was the first foreign company licensed by the Insurance Authority in KSA and is committed to delivering best-in-class health solutions aligned with Vision 2030. The organization is built on trust, clear communication, and a positive culture where leaders are consistent, approachable, and supportive.
Role Purpose
This role ensures accurate configuration, maintenance, and validation of medical benefit plans across internal systems and TPA platforms, enabling correct eligibility determination, coverage authorization, and claim processing for members, providers, and clients.
Key Responsibilities
Plan Configuration & Setup
- Analyze product documents and policy schedules to build and configure benefit plans for both internal use and TPA systems.
- Set up eligibility, copays, deductibles, out-of-pocket maximums, covered services, provider networks, annual and lifetime caps, and service-level exclusions and inclusions.
- Conduct benefit mapping and configure data exchange with TPAs using configuration manuals and documents.
System Integration & Validation
- Maintain and validate API and data feed integration between internal systems and TPA systems, including policy enrollment, benefit tables, and provider networks.
- Participate in User Acceptance Testing (UAT) for plan benefit setups and system enhancements.
- Review and validate group setup and benefit plan changes, updates, and renewals before policy activation to avoid claim errors.
Stakeholder Coordination
- Work closely with underwriting, sales, Business Support, and policy validation teams to ensure accurate reflection of client and product specifications.
- Coordinate with TPAs to align benefit configuration between internal systems and TPA platforms.
- Partner with broader Operations teams, including business support, eligibility, compliance, contact center, and claims, to ensure Operational Readiness by the client's effective date.
- Gather accurate plan information from underwriting, sales, and client services teams.
Compliance & Documentation
- Maintain configuration documentation, setup logs, and audit trails as per regulator and internal compliance protocols.
- Resolve benefit-related discrepancies flagged by claims or customer service between internal systems and TPA platforms.
Qualifications & Experience
- Bachelor's degree in healthcare administration, Business, or related field, or equivalent work experience.
- One to two years of experience in benefit setup or insurance policy administration within a health insurance company.
- Experience with benefit configuration tools and administrative platforms.
- Familiarity with medical coverages and exclusions, policy wording, and product structure.
- Knowledge of insurance regulatory requirements including CHI, IA, and Nphies.
Skills & Competencies
- Knowledge of regulatory standards, benefits, and products.
- Excellent attention to detail and analytical skills.
- Proficient in MS Office, including Excel and Word, and data entry systems.
- Strong understanding of benefit structures in small and medium enterprise (SME) and corporate policies.
- Experience working with TPA platforms and insurance core systems.
Additional Information
- Competitive salary aligned with the market.
- Multicultural and hybrid working environment.
- Private Medical Insurance.
- Employee Wellbeing Benefits.
- Educational Development Program supporting continuous learning and growth.