Job Responsibilities To provide advice, sound judgment and recommendation. Provide advice with appropriate referrals/ escalations as and when needed. To authorize, deny and determine extent of insurers liability on case of discharge. To ensure claims recommendations and decisions are complied with legal requirements, industry regulations, company policies and professional codes. To report to Manager of any claims fraudulent. To assist manager on establish strategies to manage the cost of health insurance. Ensure cost containment is practiced when adjudicating claims. Performing internal audit on claim assessment accuracy by recording errors notice in claim audit sheet. Prepare and analyze audit results, provide improvement suggestion to manager. Ensure no delay in the provision of services and cases to be closed in a timely manner within the agreed SLA. Execute SOPs, best practices, ISO policies and ensure compliance with policies. This shall include compliance of legislative requirement such as data protection and medical confidentiality. Ensure internal customer requests / inquiries for retrieval of claim documents are well attended on timely manner. Respond to clients enquiries via phone calls, e-mails and faxes within agreed client SLA, offering appropriate solutions and information. To cross-expose to any other areas/ team intra or inter department, to take up any other tasks as deemed fit or as assigned by the reporting supervisor when needed. Job Requirements Degree in Science/Nursing/Medical bioscience or related field. Fresh Graduates are welcomed. Good spoken and written communication skills are necessary for daily contact with customers, providers and inter-offices. Proficient in both spoken and written English, Bahasa Malaysia & Chinese (Cantonese/Mandarin).\xef\xbb\xbf Remuneration \xef\xbb\xbfRM2,500 - RM4,500 Consultant In Charge Ashley Yuen | ashley.yuen@hunters-in.com | 017 819 9737 \xef\xbb\xbfRodney Chong | rodney.chong@hunters-in.com | 016 8382 188
We are in the unique position of operating with MNC-level precision while having the lean agility of an SME to respond quickly to your HR needs.
Bachelor\'s or Equivalent