Complaints Analyst (APAC) - Cigna Healthcare

Job description

APAC Complaints Analyst Location: Kuala Lumpur | Function: APAC Complaints | Role type: Complaint investigation and resolution Role purpose Own and resolve APAC complaints from identification through to final response. You will deliver fair, evidence-based outcomes; communicate clearly and empathetically; maintain complete and auditable case records; and use complaint insight to reduce repeat issues and improve the member experience. The role works across claims, clinical, customer service, client management, compliance and other specialist teams, with appropriate escalation of complex, sensitive or high-risk cases. Key outcomes Complaints are identified, acknowledged, investigated and resolved within applicable service and regulatory timelines. Decisions are fair, consistent, evidence-based and supported by a clear rationale. Members receive timely updates and clear, empathetic final responses. Case records are accurate, complete and audit-ready. Customer risk, vulnerability, foreseeable harm and compliance concerns are identified and escalated promptly. Root causes, trends and corrective actions are captured to support continuous improvement. What you’ll do Manage an allocated caseload end to end, prioritising work by deadline, complexity and customer risk. Recognise and accurately record formal complaints, distinguishing them from service queries and escalations. Gather and assess relevant evidence, including calls, correspondence, system notes, policy terms, benefit information and stakeholder input. Build a clear chronology, identify the root cause and test whether processes, decisions and communications were correct and reasonable. Interpret policy terms and operational guidance accurately, seeking specialist input where required. Reach balanced, defensible outcomes and recommend proportionate financial or non-financial redress within delegated authority. Produce clear acknowledgements, progress updates and final responses that explain the evidence, decision, rationale, remedy and escalation rights. Maintain complete and auditable records in Salesforce and relevant trackers, including actions, evidence, decisions, root causes and remediation. Identify vulnerability, foreseeable harm, data privacy, fraud, sanctions, clinical, legal or regulatory concerns and follow the appropriate escalation route. Collaborate with claims, clinical, customer service, client management, compliance and other partners to remove blockers and secure timely resolution. Escalate complex, sensitive, high-value or precedent-setting cases promptly, providing a concise summary and recommended next steps. Contribute to quality reviews, case calibration, coaching and knowledge sharing; apply feedback and demonstrate sustained improvement. Analyse complaint themes and repeat failure points, recording meaningful corrective actions and sharing insight with process owners. Support team service levels, workload balancing, governance reporting and transition activities as required. Measures of success Achievement of acknowledgement and resolution service levels. Quality score of 96% or above, or the current approved APAC standard. Accurate complaint classification, outcomes, root causes and remediation records. No material compliance, customer-risk or documentation failures. Effective ownership, sound judgement and appropriate use of escalation. Constructive contribution to team learning and business improvement. What you’ll bring Experience in complaint handling, claims, customer service, insurance, healthcare or another regulated environment. Strong investigation, analytical and problem-solving skills, with the ability to assess conflicting information and form a balanced view. Excellent written and verbal English, with the ability to explain complex decisions clearly, accurately and empathetically. Sound judgement and confidence to make decisions within authority, constructively challenge where appropriate and escalate risk promptly. Strong organisation and case-management skills, with the ability to manage competing priorities and deadlines without compromising quality. Customer-focused, calm and resilient when handling sensitive issues or difficult conversations. High attention to detail and commitment to accurate, auditable records. A collaborative approach and the ability to work effectively with colleagues across functions, cultures and locations. Digital confidence and the ability to learn case-management, reporting and knowledge tools; experience of Salesforce and Microsoft 365 is advantageous. A continuous-improvement mindset and willingness to participate in coaching, calibration and quality assurance. Desirable Knowledge of APAC insurance operations, medical claims or employee health benefits. Experience of root cause analysis, corrective action tracking, quality assurance or management information. Understanding of applicable local complaint requirements and external dispute-resolution arrangements, including FIDReC where relevant. Experience working with geographically dispersed stakeholders or in a transition, migration or capability-build environment. Working approach You will complete structured onboarding, knowledge assessment and supported case handling before progressing to independent ownership. Continued readiness will be evidenced through service, quality, regulatory and customer-risk measures, with targeted coaching and reassessment where needed. 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.