Individual/ Employee Benefits Claims Management (1 year contract) - Shift
Salary undisclosed
Apply on
Original
Simplified
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 (workforce management) team in ensuring sufficient headcount as scheduled on the shift rotation on a monthly basis to cater for the guarantee letter 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 guarantee letter issuance is less than the target.
- To perform other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements.
Minimum Job Requirements:
- Candidate must possess at least a Bachelor's Degree, Post Graduate Diploma, Professional Degree or Master's Degree in Dentistry, Medicine, Medical Science, Biomedical, Nursing, Pharmacy, Pharmacology, Physiotherapy or equivalent.
- Candidate with claim experience is an added advantage.
- Fresh Graduate with medical background is encouraged to apply.
- Full-Time position(s) available.
- 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.