Job Description

Job Summary:

Oversees and manages daily operations for its clients, affiliate dental and medical facility partners, and vendors in connection with appointment booking, eligibility, benefit coverage and limitation, and claims adjudications associated with a wide range of medical and dental insurance products.

Duties/Responsibilities:

Customer Service

Provide quality customer service telephonically and proper documentation via the platform with regards to appointments, benefits, and claims concerns. Properly document and update call and complaint logs as well as generate activity reports routinely. Handle inbound and outbound customer service-related calls for members and health care providers. Entry of all customer service-related information into the company's CRM tools. Processing and management of all provider and member non-voice inquiries (post, email, and fax). Transfer of select inquiries to the appropriate person or department as indicated by management. Properly document and update call and complaint logs, as well as generate activity reports on a daily, weekly, monthly, quarterly, and annual basis. Perform authorizations for simple outpatient, dental, and health care screening benefits based on coverage and member eligibility. Coordination of members' health care needs (according to benefit plan) domestically and regionally through the appropriate counterparts. Adhere to all policies and procedures that apply to each market.
Provider Recruitment and Relations

Attend provider recruitment meetings and presentation as required. Ensures that provider contacts and supporting documents are submitted in a timely manner. Manage provider service projects as needed and ensure that deadlines are met. Prepare various reports including regular updates on recruitment and service projects as directed by Management.
Claim Analysis

Retrieval of claims documents to and from mailing address. Claims processing and analysis of all claims. Compile, verify, interpret, analyze and summary of claim data and preparation of client payment report. Investigating potentially fraudulent claims. Review and obtain necessary approval of documents from policyholders and providers. Identify and resolve claim related inquiries and issues.
Adaptation of Responsibilities Based on Business Requirements in Cases of Limited Transactions

In the event of limited or no transactions, the Operations Coordinator may be assigned additional responsibilities to support the team's ongoing needs.
Job Type: Full-time

Pay: From RM6,000.00 per month

Benefits:

Work from home
Experience:

Healthcare Industry: 3 years (Required) TPA: 3 years (Preferred) Claims Analyst: 3 years (Required)
License/Certification:

SCI Certification in General Insurance (Required)
Work Location: Remote