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Individual/ Employee Benefits Claims Management (1 year contract) - Shift

Salary undisclosed

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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.