Job Description

About the Role

Responsible for performing pre-certification; prospective, concurrent and retrospective review of hospitalization; and to ensure that cost containment measures are carried out without compromising on the care quality and service standards.

Roles and Responsibilities:

• To support and lead a team of assessors in pre-certification, hospitalization, case management in the issuance of guarantee letter in compliance to Company\'s requirements and guidelines.
• To ensure quality audits are done for the respective team members.
• To pre-certify cases for issuance of guarantee letter in compliance to Company\'s requirements and guidelines assist the team target productivity benchmark.
• To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.
• To assist in the assignment and monitoring of all documents received in their respective team\'s queues.
• To assist WFM team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the GL process.
• To ensure huddles and communications are carried out as per the agreed frequency.
• To ensure coaching and engagement activities are carried out for performance improvement and cost containment.
• To ensure that cases of fee disputes are handled and resolved within targeted TAT.
• To ensure that error rate in GL issuance is less that the target.
• To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements .

Education: Bachelor\'s Degree in Medicine or medical fields

Years of Experience: Minimum 2 years of experience

Technical Skills: Claims assessment, Medical report knowledge, Health Insurance Policy knowledge

Industry: Health Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs

Language: English and Bahasa Malaysia

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