Job Description

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Client Background: Belgium MNC- one of the largest health service organizations with 60 million customer relationships across the world and support this with a worldwide staff of 30,000 employees.

Industry: Insurance Service Provider

Location: KL

Headcount: 1 headcount

Tenure: Permanent

Remuneration: RM350 WFH Allowance + Yearly Flexi Allowance + Birthday leave + Bonuses & more

Responsibilities:

Responsible of serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests and maintaining database.

He/She is responsible for processing as per terms of benefits.

He/She should provide accurate and relevant medical coverage details and maintain pre-approvals and claims processing as per the defined terms and policies of the organization.

Processes claims from members and providers.

Assists queries from providers and payers via phone calls or e-mails.

Maintains files for authorizations and other reports.

Assesses and processes claims in line with the policy coverage and medical necessity.

Be fully versed with medical insurance policies for various groups / beneficiaries.

May assist in training colleagues and asked to share knowledge.

Accurately assesses eligibility within the policy boundaries.

Monitors and maintains the claims processing as per the defined terms and policy of the organization.

Achieves required processing targets assigned by the team leader on daily, weekly, and monthly basis.

Monitors the qualitative and quantitative measures for claims & pre-approvals.

Ensures compliance to any changes in terms of system parameters or process.

Maintains quality as per framework for accuracy.

Maintains productivity and responsiveness to the work allocated.

Collaborate with other stakeholders / teams to resolve queries including complex queries.

Actively support all team members to enable operational goals to be achieved.

Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score).

Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality.

Accurate data input to the system applications.

Sub Specialization : Administration;Administration Support
Type of Employment : Permanent
Minimum Experience : 2 Years
Work Location : Kuala Lumpur

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